NPIMap

Organization Active NPI

Gregory J. Kuchtjak, D.M.D., P.a.

  • Dentist
  • Statesville, NC
National Provider Identifier
1871750745
Registry record updated May 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
7068 Issued in NC
Legal business name
GREGORY J. KUCHTJAK, D.M.D., P.A.
Practice address
933 N Carolina Ave
Statesville, NC 28677-3414
Phone
(704) 883-8516
Fax
(704) 883-8560
NPI assigned
May 19, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Gregory J. Kuchtjak, D.M.D.NPI 1265440192
Title
President/Pediatric Dentist
Phone
(704) 883-8516

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 7068 NC Primary

Addresses

Primary practice location

933 N Carolina Ave
Statesville, NC 28677-3414

Mailing address

933 N Carolina Ave
Statesville, NC 28677-3414
Phone (704) 883-8516

Other identifiers 1

IdentifierTypeStateIssuer
902VGOtherNCBLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory

Locations

933 N Carolina Ave
Statesville, NC 28677
Phone (704) 883-8516

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1211155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211241600000",
    "number": "1871750745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "933 N CAROLINA AVE",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286773414",
            "telephone_number": "704-883-8516",
            "fax_number": "704-883-8560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "933 N CAROLINA AVE",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286773414",
            "telephone_number": "704-883-8516",
            "fax_number": "704-883-8560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREGORY J. KUCHTJAK, D.M.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-19",
        "last_updated": "2008-05-20",
        "status": "A",
        "authorized_official_last_name": "KUCHTJAK",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT/PEDIATRIC DENTIST",
        "authorized_official_telephone_number": "704-883-8516",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NC",
            "license": "7068",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "902VG",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Statesville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.