Organization
MI DENTISTA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW KUTZ DDS (OWNER)
(608) 658-4600
Entity
Organization
Contact information
Practice address
4801 COTTAGE GROVE RD STE D, MADISON, WI 53716-1349
(608) 658-4600
Mailing address
4801 COTTAGE GROVE RD STE D, MADISON, WI 53716-1349
(608) 658-4600
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5729-015
WI
Other
Enumeration date
11/25/2014
Last updated
11/25/2014
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