Provider Demographics
NPI:1669711644
Name:CUTTER, ALEJANDRA DEFUENTES
Entity type:Individual
Prefix:DR
First Name:ALEJANDRA
Middle Name:DEFUENTES
Last Name:CUTTER
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:ALEJANDRA
Other - Middle Name:
Other - Last Name:DEFUENTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50255 BOARDWALK AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-0136
Mailing Address - Country:US
Mailing Address - Phone:248-892-7651
Mailing Address - Fax:
Practice Address - Street 1:980 ANN ARBOR RD W
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-2139
Practice Address - Country:US
Practice Address - Phone:734-453-9413
Practice Address - Fax:734-453-9197
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-11
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010208501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice