MEDICARE: DOUGLAS A TUTTEROW DDS PA

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	1223G0001X	General Practice Dentistry	5245	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306980362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOUGLAS A TUTTEROW DDS PA

Provider Business Mailing Address
First Line	:	4680 YADKINVILLE RD
Second Line	:
City	:	PFAFFTOWN
State	:	NC
Zip	:	27040-8622
Country	:	US
Telephone Number	:	336-924-9555
Fax Number	:	336-924-3168

Provider Business Practice Location Address
First Line	:	4680 YADKINVILLE RD
Second Line	:
City	:	PFAFFTOWN
State	:	NC
Zip	:	27040-8622
Country	:	US
Telephone Number	:	336-924-9555
Fax Number	:	336-924-3168

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DOUGLAS ALAN TUTTEROW
Credential	:	DDS
Telephone Number	:	336-924-9555

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	06/12/2008

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