Healthcare Provider Details

I. General information

NPI: 1184817405
Provider Name (Legal Business Name): JOSEPH MICHAEL DUTNER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 LINCOLN STREET
TACOMA WA
98431-0001
US

IV. Provider business mailing address

9900 LINCOLN STREET
TACOMA WA
98431-1100
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-4079
  • Fax:
Mailing address:
  • Phone: 253-968-4079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number6058-015
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6058-015
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: