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General NPI Number Information
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NPI Number | 1003929969
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Entity Type | Individual
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Provider Name | VINCENT MILES LUTTERBIE DDS
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Gender | Male
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | LINCOLN AND SLATER STREETS
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City | MARSHALL
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State | MO
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Zip | 65340
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Country | US
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Telephone | 660-886-2202
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Fax | 660-886-3047
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Provider Business Mailing Address
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Address Line | PO BOX 190
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City | MARSHALL
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State | MO
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Zip | 65340
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Country | US
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Telephone | 660-886-2202
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Fax | 660-886-3047
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0013387
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License Number State | MO
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