MEDICARE: CAROLINE E TUTTLE DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		NJ
2	1223G0001X	General Practice Dentistry	22DI02647300	NJ
3	1223G0001X	General Practice Dentistry	22DI02647301	NJ

General Provider Information

NPI Number	:	1053766154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE E TUTTLE DMD

Provider Business Mailing Address
First Line	:	330 PRINCETON HIGHTSTOWN RD
Second Line	:
City	:	WEST WINDSOR
State	:	NJ
Zip	:	08550-3125
Country	:	US
Telephone Number	:	609-799-2929
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 PRINCETON HIGHTSTOWN RD
Second Line	:
City	:	WEST WINDSOR
State	:	NJ
Zip	:	08550-3125
Country	:	US
Telephone Number	:	609-799-2929
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2016
Last Update Date	:	04/06/2017

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