Healthcare Provider Details

I. General information

NPI: 1720247349
Provider Name (Legal Business Name): ANDREA MARIE HUTTON D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 MANCHESTER AVE
WABASH IN
46992-1808
US

IV. Provider business mailing address

278 MANCHESTER AVE
WABASH IN
46992-1808
US

V. Phone/Fax

Practice location:
  • Phone: 260-563-4065
  • Fax:
Mailing address:
  • Phone: 260-563-4065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12011167A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: