Provider Demographics
NPI:1598146425
Name:HUTTON, EMALIE (DDS)
Entity Type:Individual
Prefix:
First Name:EMALIE
Middle Name:
Last Name:HUTTON
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 1:311 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-3101
Mailing Address - Country:US
Mailing Address - Phone:931-388-1935
Mailing Address - Fax:931-388-2336
Practice Address - Street 1:311 W 8TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3101
Practice Address - Country:US
Practice Address - Phone:931-388-1935
Practice Address - Fax:931-388-2336
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-16
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10073122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN10073Other833653828