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General NPI Number Information
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NPI Number | 1407371511
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Entity Type | Individual
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Provider Name | DALE LOUIS MCNUTT DMD
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Gender | Male
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Dates
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Enumeration Date | 08/09/2017
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Last Update Date | 07/16/2019
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Provider Practice Location Address
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Address Line | 1683 W HARVARD AVE
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City | ROSEBURG
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State | OR
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Zip | 97471-2812
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Country | US
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Telephone | 541-378-4141
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Fax |
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Provider Business Mailing Address
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Address Line | 6950 NE CAMPUS WAY
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City | HILLSBORO
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State | OR
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Zip | 97124-5611
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Country | US
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Telephone |
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Fax |
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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 | D10715
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License Number State | OR
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