Healthcare Provider Details

I. General information

NPI: 1235155516
Provider Name (Legal Business Name): GEORGE HUTTON STUPPY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 ROUTE #41
CHRISTIANA PA
17509
US

IV. Provider business mailing address

355 ROUTE #41 PO BOX 156
CHRISTIANA PA
17509
US

V. Phone/Fax

Practice location:
  • Phone: 610-593-2818
  • Fax: 610-593-5167
Mailing address:
  • Phone: 610-593-2818
  • Fax: 610-593-5167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS021015L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: