Healthcare Provider Details

I. General information

NPI: 1083747018
Provider Name (Legal Business Name): MICHAEL D TUTTLE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W 14TH ST
WILMINGTON DE
19801-1013
US

IV. Provider business mailing address

111 CYPRESS DR DR
NEWARK DE
19713-2881
US

V. Phone/Fax

Practice location:
  • Phone: 302-428-4850
  • Fax: 302-428-4814
Mailing address:
  • Phone: 302-540-9538
  • Fax: 302-428-4814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberG3-0000322
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: