Provider Demographics
NPI:1376036764
Name:GLADSTONE SMILES DENTISTRY PC
Entity Type:Organization
Organization Name:GLADSTONE SMILES DENTISTRY PC
Other - Org Name:GLADSTONE SMILES DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:TUTT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:714-845-8701
Mailing Address - Street 1:PO BOX 920050
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75392-0050
Mailing Address - Country:US
Mailing Address - Phone:714-845-8500
Mailing Address - Fax:303-952-0982
Practice Address - Street 1:20140 MCLOUGHLIN BLVD
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:OR
Practice Address - Zip Code:97027
Practice Address - Country:US
Practice Address - Phone:503-420-3454
Practice Address - Fax:503-420-3454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-11
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty