Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DS025175L | PA |
NPI | 1083671515 |
---|---|
Provider Name | Bruce J Cutilli |
First Address | Spring House, PA 19477-0857 |
Second Address | Spring House, PA 19477-0857 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 18/09/2014 |