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General NPI Number Information
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NPI Number | 1881620375
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Entity Type | Organization
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Legal Business Name | R. GRAY TUTTLE III, DDS,PLLC
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1341 WESTGATE CENTER DR SUITE A
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City | WINSTON-SALEM
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State | NC
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Zip | 27103-2934
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Country | US
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Telephone | 336-768-1712
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Fax |
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Provider Business Mailing Address
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Address Line | 1341 WESTGATE CENTER DR SUITE A
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City | WINSTON-SALEM
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State | NC
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Zip | 27103-2934
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Country | US
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Telephone | 336-768-1712
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Fax |
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Authorized Official
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Title or Position | DDS PLLC
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Name | DR. REUBEN GRAY TUTTLE III
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Credential | DDS
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Telephone | 336-768-1712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 103620
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License Number State | NC
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