Provider Demographics
NPI:1104980945
Name:STUTTS, JEFF DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFF
Middle Name:DAVID
Last Name:STUTTS
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 1:610 BOARDWALK AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718
Mailing Address - Country:US
Mailing Address - Phone:406-582-8010
Mailing Address - Fax:406-582-5183
Practice Address - Street 1:610 BOARDWALK AVE
Practice Address - Street 2:STE 201
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718
Practice Address - Country:US
Practice Address - Phone:406-582-8010
Practice Address - Fax:406-582-5183
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT20761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice