Provider Demographics
NPI:1881799484
Name:MCCUTCHEON, MICHAEL O (DMD, PC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:O
Last Name:MCCUTCHEON
Suffix:
Gender:M
Credentials:DMD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 HIGHWAY 31 N.W.
Mailing Address - Street 2:SUITE B
Mailing Address - City:HARTSELLE
Mailing Address - State:AL
Mailing Address - Zip Code:35640-1148
Mailing Address - Country:US
Mailing Address - Phone:256-773-6579
Mailing Address - Fax:256-773-6570
Practice Address - Street 1:819 HIGHWAY 31 N.W.
Practice Address - Street 2:SUITE B
Practice Address - City:HARTSELLE
Practice Address - State:AL
Practice Address - Zip Code:35640-1148
Practice Address - Country:US
Practice Address - Phone:256-773-6579
Practice Address - Fax:256-773-6570
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL44501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice