Provider Demographics
NPI:1518088715
Name:NUTTER, DAVID LEROY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEROY
Last Name:NUTTER
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 1:300 SE 120TH AVE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-4090
Mailing Address - Country:US
Mailing Address - Phone:360-892-1170
Mailing Address - Fax:360-604-1172
Practice Address - Street 1:300 SE 120TH AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-4090
Practice Address - Country:US
Practice Address - Phone:360-892-1170
Practice Address - Fax:360-604-1172
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00049591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice