Provider Demographics
NPI:1386009884
Name:DENNIS PAUL NUTTER DDS, INC
Entity Type:Organization
Organization Name:DENNIS PAUL NUTTER DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:NUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-422-5444
Mailing Address - Street 1:3694 HILBORN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-7994
Mailing Address - Country:US
Mailing Address - Phone:707-422-5444
Mailing Address - Fax:707-422-1613
Practice Address - Street 1:3694 HILBORN RD STE 100
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-7994
Practice Address - Country:US
Practice Address - Phone:707-422-5444
Practice Address - Fax:707-422-1613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA280541223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB28054OtherDENTI-CAL