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General NPI Number Information
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NPI Number | 1053974196
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Entity Type | Organization
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Legal Business Name | BRIAN K. HUTTO, DMD, INC.
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Dates
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Enumeration Date | 04/15/2019
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Last Update Date | 02/04/2024
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Provider Practice Location Address
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Address Line | 2301 ST PAULS WAY
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City | MODESTO
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State | CA
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Zip | 95355-3309
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Country | US
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Telephone | 209-522-5238
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Fax | 209-522-4703
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Provider Business Mailing Address
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Address Line | 1213 COFFEE RD STE D
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City | MODESTO
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State | CA
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Zip | 95355-4229
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Country | US
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Telephone | 209-522-5238
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRIAN K HUTTO
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Credential | DMD
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Telephone | 209-522-5238
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number |
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License Number State |
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