Healthcare Provider Details

I. General information

NPI: 1043601891
Provider Name (Legal Business Name): HUTTA BROTHERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2015
Last Update Date: 02/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 HOFF RD SUITE A
WESTERVILLE OH
43082-7156
US

IV. Provider business mailing address

214 HOFF RD SUITE A
WESTERVILLE OH
43082-7156
US

V. Phone/Fax

Practice location:
  • Phone: 614-423-8177
  • Fax: 614-423-8175
Mailing address:
  • Phone: 614-423-8177
  • Fax: 614-423-8175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberOH18975
License Number StateOH

VIII. Authorized Official

Name: DR. JAMES THOMAS HUTTA
Title or Position: OWNER
Credential: D.D.S.
Phone: 614-855-8800