Provider Demographics
NPI:1043220312
Name:TUTOR, HEATHER KILLEBREW (DMD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:KILLEBREW
Last Name:TUTOR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 CARROLLTON AVE
Mailing Address - Street 2:P O BOX 734
Mailing Address - City:LEXINGTON
Mailing Address - State:MS
Mailing Address - Zip Code:39095-3250
Mailing Address - Country:US
Mailing Address - Phone:662-834-9899
Mailing Address - Fax:662-834-9895
Practice Address - Street 1:102 CARROLLTON AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MS
Practice Address - Zip Code:39095-3250
Practice Address - Country:US
Practice Address - Phone:662-834-9899
Practice Address - Fax:662-834-9895
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3145-001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015878Medicaid