Provider Demographics
NPI:1346477056
Name:NUTTING, JACLYN TALIA (DDS)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:TALIA
Last Name:NUTTING
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6025 BROOKVALE LN
Mailing Address - Street 2:SUITE 110
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-4031
Mailing Address - Country:US
Mailing Address - Phone:865-300-3149
Mailing Address - Fax:
Practice Address - Street 1:6025 BROOKVALE LN
Practice Address - Street 2:SUITE 110
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-4031
Practice Address - Country:US
Practice Address - Phone:865-588-5761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN90281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice