Basic Information
Provider Information
NPI: 1750767380
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KRUTSINGER
FirstName: CATARINA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 203 S ROLLIE AVE
Address2:  
City: FORT LUPTON
State: CO
PostalCode: 806211508
CountryCode: US
TelephoneNumber: 3032864560
FaxNumber: 3032864589
Practice Location
Address1: 1635 BLUE SPRUCE DR
Address2:  
City: FORT COLLINS
State: CO
PostalCode: 805245427
CountryCode: US
TelephoneNumber: 9704840999
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/05/2015
LastUpdateDate: 09/02/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000XDEN.00202608COY Dental ProvidersDentist 

No ID Information.


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