Healthcare Provider Details

I. General information

NPI: 1467958272
Provider Name (Legal Business Name): VICTORIA LEIGH HUTTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 04/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W 12TH AVE
COLUMBUS OH
43210-1267
US

IV. Provider business mailing address

305 W 12TH AVE
COLUMBUS OH
43210-1267
US

V. Phone/Fax

Practice location:
  • Phone: 614-595-6010
  • Fax:
Mailing address:
  • Phone: 614-595-6010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.025143
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: