Healthcare Provider Details

I. General information

NPI: 1740068428
Provider Name (Legal Business Name): JAMES T HUTTA, DDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2023
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

5300 PATTERSON AVE SE STE 110
GRAND RAPIDS MI
49512-9758
US

V. Phone/Fax

Practice location:
  • Phone: 614-885-2000
  • Fax:
Mailing address:
  • Phone: 616-283-8867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STACY POPE
Title or Position: PROJECT MANAGER
Credential:
Phone: 616-283-8867