Provider Demographics
NPI:1174688642
Name:TUTTEROW, DOUG A (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUG
Middle Name:A
Last Name:TUTTEROW
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:PO BOX 518
Mailing Address - Street 2:4680 YADKINVILLE RD
Mailing Address - City:PFAFFTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27040
Mailing Address - Country:US
Mailing Address - Phone:336-924-9555
Mailing Address - Fax:
Practice Address - Street 1:4680 YADKINVILLE RD
Practice Address - Street 2:
Practice Address - City:PFAFFTOWN
Practice Address - State:NC
Practice Address - Zip Code:27040
Practice Address - Country:US
Practice Address - Phone:336-924-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC52451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4998654Medicaid