Healthcare Provider Details

I. General information

NPI: 1225205628
Provider Name (Legal Business Name): JOSEPH LAWRENCE HUTTA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5152 BLAZER MEMORIAL PKWY SUITE 200
DUBLIN OH
43017-7315
US

IV. Provider business mailing address

6641 N HIGH ST SUITE 104
WORTHINGTON OH
43085-4038
US

V. Phone/Fax

Practice location:
  • Phone: 614-734-9000
  • Fax:
Mailing address:
  • Phone: 614-885-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number30017355
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: