Provider Demographics
NPI:1447371729
Name:MCCUTCHEON, MICHAEL CURTIS (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CURTIS
Last Name:MCCUTCHEON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:BARLOW
Mailing Address - State:OH
Mailing Address - Zip Code:45712-0159
Mailing Address - Country:US
Mailing Address - Phone:740-678-0083
Mailing Address - Fax:740-678-7833
Practice Address - Street 1:8400 STATE ROUTE 339
Practice Address - Street 2:
Practice Address - City:VINCENT
Practice Address - State:OH
Practice Address - Zip Code:45784
Practice Address - Country:US
Practice Address - Phone:740-678-0083
Practice Address - Fax:740-678-7833
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-02-03051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice