Provider Demographics
NPI:1629107602
Name:MCNUTT, STEVEN CRAIG (DDS, PA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:CRAIG
Last Name:MCNUTT
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:320 AVENUE K SE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-4147
Mailing Address - Country:US
Mailing Address - Phone:863-294-6565
Mailing Address - Fax:863-295-9164
Practice Address - Street 1:320 AVENUE K SE
Practice Address - Street 2:SUITE #2
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-4147
Practice Address - Country:US
Practice Address - Phone:863-294-6565
Practice Address - Fax:863-295-9164
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLDN 121771223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics