Provider Demographics
NPI:1376538462
Name:TUTTLE, GREGORY DUANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:DUANE
Last Name:TUTTLE
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 1:944 HEATHERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:SD
Mailing Address - Zip Code:57042-3721
Mailing Address - Country:US
Mailing Address - Phone:605-556-0035
Mailing Address - Fax:
Practice Address - Street 1:801 3RD ST. SW
Practice Address - Street 2:
Practice Address - City:DESMET
Practice Address - State:SD
Practice Address - Zip Code:57231
Practice Address - Country:US
Practice Address - Phone:605-854-3444
Practice Address - Fax:605-854-9952
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM659122300000X, 1223D0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223D0001XDental ProvidersDentistDental Public Health
Not Answered1223G0001XDental ProvidersDentistGeneral Practice