Provider Demographics
NPI:1538496385
Name:TUTTLE, DELIA (DDS)
Entity Type:Individual
Prefix:
First Name:DELIA
Middle Name:
Last Name:TUTTLE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13040 ESSEN LN
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-6757
Mailing Address - Country:US
Mailing Address - Phone:951-616-8209
Mailing Address - Fax:
Practice Address - Street 1:12625 FREDERICK ST STE F4
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-5234
Practice Address - Country:US
Practice Address - Phone:951-697-7750
Practice Address - Fax:951-697-7752
Is Sole Proprietor?:No
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58943122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist