Healthcare Provider Details

I. General information

NPI: 1659594000
Provider Name (Legal Business Name): DEBORAH MARIE HUTTON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N MOUNTAIN AVE # A205
UPLAND CA
91786
US

IV. Provider business mailing address

600 N MOUNTAIN AVE # A205
UPLAND CA
91786
US

V. Phone/Fax

Practice location:
  • Phone: 909-982-8836
  • Fax: 909-982-5758
Mailing address:
  • Phone: 909-982-8836
  • Fax: 909-982-5758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30187
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number44422
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number51233
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: