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NPI Code Detail

MEDICARE: MATTHEW NUTTALL

MEDICARE: MATTHEW NUTTALL
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
11223G0001XGeneral Practice Dentistry60750254WA

General Provider Information

NPI Number : 1174051197
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW NUTTALL
Provider Business Mailing Address
First Line : 5908 63RD AVENUE CT NW
Second Line :
City : GIG HARBOR
State : WA
Zip : 98335-7388
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2501 N PEARL ST
Second Line :
City : TACOMA
State : WA
Zip : 98406-2540
Country : US
Telephone Number : 253-752-6349
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2017
Last Update Date : 06/03/2017

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Directions to “ MATTHEW NUTTALL ” Practice Location

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