Provider Demographics
NPI:1689986358
Name:TUFT, HEBER CUTLER
Entity Type:Individual
Prefix:
First Name:HEBER
Middle Name:CUTLER
Last Name:TUFT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 PARGOUD LNDG
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-2300
Mailing Address - Country:US
Mailing Address - Phone:318-450-7953
Mailing Address - Fax:
Practice Address - Street 1:3809 WHITES FERRY RD
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-2006
Practice Address - Country:US
Practice Address - Phone:318-396-6204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA59171223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry