Provider Demographics
NPI:1740297852
Name:KUTTLER, SERGIO (BS, DDS)
Entity type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:
Last Name:KUTTLER
Suffix:
Gender:M
Credentials:BS, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11202 NW 9TH STREET
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33325-1523
Mailing Address - Country:US
Mailing Address - Phone:954-900-4305
Mailing Address - Fax:
Practice Address - Street 1:11202 NW 9TH ST
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33325-1523
Practice Address - Country:US
Practice Address - Phone:954-900-4305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDTP2791223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics