Individual
BRENT KUTLESA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
100 W 15TH ST, EDMOND, OK 73013-3603
(405) 330-2123
(405) 285-4695
Mailing address
100 W 15TH ST, EDMOND, OK 73013-3603
(405) 330-2123
(405) 285-4695
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6288
OK
Other
Enumeration date
06/21/2011
Last updated
06/21/2011
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