Provider Demographics
NPI:1114906187
Name:HUTTULA, ANDREW SCOTT (DDS)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:SCOTT
Last Name:HUTTULA
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 1:303 WILLIAMS AVE SW
Mailing Address - Street 2:STE 1011
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6097
Mailing Address - Country:US
Mailing Address - Phone:256-533-3480
Mailing Address - Fax:
Practice Address - Street 1:1140 EAGLETREE LN SE
Practice Address - Street 2:SUITE 100
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6446
Practice Address - Country:US
Practice Address - Phone:256-533-3480
Practice Address - Fax:256-534-6915
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS76981223E0200X
AL55991223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
000OTHMedicare UPIN