Provider Demographics
NPI:1588015069
Name:HUTTON, SAMUEL JAMES (DDS)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:JAMES
Last Name:HUTTON
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 1:1169 UNION AVE APT 453
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-6679
Mailing Address - Country:US
Mailing Address - Phone:931-797-5748
Mailing Address - Fax:
Practice Address - Street 1:2500 BROWNS LN STE B
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6107
Practice Address - Country:US
Practice Address - Phone:870-972-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4119122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist