Provider Demographics
NPI:1396031043
Name:TUTOR, VANCE WESLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:VANCE
Middle Name:WESLEY
Last Name:TUTOR
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 1:766 S. WHITE STATION RD. STE 1
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117
Mailing Address - Country:US
Mailing Address - Phone:901-685-8090
Mailing Address - Fax:901-684-1662
Practice Address - Street 1:766 S. WHITE STATION RD. STE 1
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117
Practice Address - Country:US
Practice Address - Phone:901-685-8090
Practice Address - Fax:901-684-1662
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3829122300000X
TNDS00000106731223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR187779608OtherARKIDS, MEDICAID