Provider Demographics
NPI:1144452426
Name:MCCUTCHEON, PETER CHRISTOPHER (DDS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:CHRISTOPHER
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:P.O. BOX 68
Mailing Address - Street 2:317 #2, THIRD ST.
Mailing Address - City:KOTZEBUE
Mailing Address - State:AK
Mailing Address - Zip Code:99752-0068
Mailing Address - Country:US
Mailing Address - Phone:907-442-7325
Mailing Address - Fax:
Practice Address - Street 1:436 FIFTH ST.
Practice Address - Street 2:TED STEVENS WAY
Practice Address - City:KOTZEBUE
Practice Address - State:AK
Practice Address - Zip Code:99752
Practice Address - Country:US
Practice Address - Phone:907-442-7325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV32611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice