Healthcare Provider Details

I. General information

NPI: 1508037243
Provider Name (Legal Business Name): DARRELL MITCHELL HUTTO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2008
Last Update Date: 03/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

2500 N STATE ST
JACKSON MS
39216-4500
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-6030
  • Fax: 601-815-3901
Mailing address:
  • Phone: 601-984-6030
  • Fax: 601-815-3901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3404-06
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: