Provider Demographics
NPI:1417370933
Name:DR. DAVID R. HUTTO DMD
Entity Type:Organization
Organization Name:DR. DAVID R. HUTTO DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RUPLE
Authorized Official - Last Name:HUTTO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-536-9300
Mailing Address - Street 1:1380 PARK ST
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-4880
Mailing Address - Country:US
Mailing Address - Phone:803-536-9300
Mailing Address - Fax:803-536-6922
Practice Address - Street 1:1380 PARK ST
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-4880
Practice Address - Country:US
Practice Address - Phone:803-536-9300
Practice Address - Fax:803-536-6922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2074122300000X
SC8232122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX8232Medicaid
SCZ27043Medicaid