Provider Demographics
NPI:1790796092
Name:TUTTLE, LAWRENCE ALAN (DDS)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:ALAN
Last Name:TUTTLE
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 1:3313 N GRIMES ST
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-1219
Mailing Address - Country:US
Mailing Address - Phone:575-392-4290
Mailing Address - Fax:575-392-1982
Practice Address - Street 1:3313 N GRIMES
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240
Practice Address - Country:US
Practice Address - Phone:505-392-4290
Practice Address - Fax:505-392-1982
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM13661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice