Provider Demographics
NPI:1083097299
Name:JUTRIC, DAMJAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAMJAN
Middle Name:
Last Name:JUTRIC
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10828 GRAVELLY LAKE DR SW STE 111
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-1300
Mailing Address - Country:US
Mailing Address - Phone:253-584-3121
Mailing Address - Fax:
Practice Address - Street 1:10828 GRAVELLY LAKE DR SW STE 111
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-1300
Practice Address - Country:US
Practice Address - Phone:253-584-3121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31161122300000X
WADE60729364122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist