Healthcare Provider Details

I. General information

NPI: 1376567123
Provider Name (Legal Business Name): JOSHUA TODD HUTTER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 12/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 LAWRENCE BELL DR SUITE 102
WILLIAMSVILLE NY
14221-7817
US

IV. Provider business mailing address

3990 MCKINLEY PKWY SUITE 2
BLASDELL NY
14219-2900
US

V. Phone/Fax

Practice location:
  • Phone: 716-634-4679
  • Fax: 716-634-5415
Mailing address:
  • Phone: 716-649-1307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number50-052721
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: