Provider Demographics
NPI:1447402243
Name:HUTABARAT, MORRIS ARNOLD (DDS)
Entity Type:Individual
Prefix:DR
First Name:MORRIS
Middle Name:ARNOLD
Last Name:HUTABARAT
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:PO BOX 5004
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60522-5004
Mailing Address - Country:US
Mailing Address - Phone:630-572-9696
Mailing Address - Fax:630-572-9743
Practice Address - Street 1:5330 W DEVON AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-4148
Practice Address - Country:US
Practice Address - Phone:773-763-9696
Practice Address - Fax:773-763-8767
Is Sole Proprietor?:No
Enumeration Date:2008-10-13
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0217041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice