Healthcare Provider Details

I. General information

NPI: 1679638282
Provider Name (Legal Business Name): ROBERT M DUTTON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 STATE ROUTE 375 SUITE ONE
WEST HURLEY NY
12491-5633
US

IV. Provider business mailing address

275 STATE ROUTE 375 SUITE ONE
WEST HURLEY NY
12491-5633
US

V. Phone/Fax

Practice location:
  • Phone: 845-679-9744
  • Fax:
Mailing address:
  • Phone: 845-679-9744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number033866
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: