Healthcare Provider Details

I. General information

NPI: 1235289893
Provider Name (Legal Business Name): MARK CHRISTIAN HUTTEN D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E HURON ST GALTER PAVILION, SUITE 2-246
CHICAGO IL
60611-3197
US

IV. Provider business mailing address

201 E HURON ST GALTER PAVILION, SUITE 2-246
CHICAGO IL
60611-3197
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-3264
  • Fax: 312-926-3885
Mailing address:
  • Phone: 312-926-3264
  • Fax: 312-926-3885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: