Provider Demographics
NPI:1639726292
Name:LUTTRELL, CLIFFORD DEAN JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:DEAN
Last Name:LUTTRELL
Suffix:JR
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 1:205 CROATAN WOODS DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-9830
Mailing Address - Country:US
Mailing Address - Phone:830-446-2420
Mailing Address - Fax:
Practice Address - Street 1:2D DENBN/NDC
Practice Address - Street 2:PSC 20130
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28542
Practice Address - Country:US
Practice Address - Phone:252-466-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35641122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist