Mi Dentista LLC

NPI #1891192415 in Madison, Wisconsin

Provider Information

NPI Number: 1891192415
Entity Type: Organization
Organization Name: Mi Dentista LLC
Primary Specialty: Dentist - General Practice
Enumeration Date: Nov 25, 2014
Last Updated: Nov 25, 2014

Practice Location

Address: 4801 COTTAGE GROVE RD STE D
City: Madison
State: Wisconsin
ZIP Code: 53716-1349
Phone: (608) 658-4600

Authorized Official

Name: MATTHEW KUTZ, DDS
Title: OWNER
Phone: (608) 658-4600

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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