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General NPI Number Information
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NPI Number | 1871563759
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Entity Type | Individual
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Provider Name | AZURE LAARLETTA UTLEY DDS, MHA
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Gender | Female
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Dates
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Enumeration Date | 01/24/2006
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Last Update Date | 08/30/2024
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Provider Practice Location Address
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Address Line | TRIPLER ARMY MEDICAL CENTER (TAMC) DENTAL HEALTH ACTIVITY DEPARTMENT
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City | HONOLULU
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State | HI
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Zip | 96858
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Country | US
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Telephone | 808-433-5551
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Fax |
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Provider Business Mailing Address
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Address Line | BLDG 38717 38TH STREET
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City | FT GORDON
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State | GA
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Zip | 30905-5660
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Country | US
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Telephone | 706-787-6927
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Fax | 706-787-2082
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DN012978
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DT-3195
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License Number State | HI
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Taxonomy #3
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 13181
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 10176
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License Number State | NC
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