Provider Demographics
NPI:1477796977
Name:ALBERT W. TUTOR, JR., D.M.D. PA
Entity type:Organization
Organization Name:ALBERT W. TUTOR, JR., D.M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:TUTOR
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-824-3500
Mailing Address - Street 1:25 EASTGATE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-2317
Mailing Address - Country:US
Mailing Address - Phone:601-824-3500
Mailing Address - Fax:601-824-3501
Practice Address - Street 1:25 EASTGATE DR
Practice Address - Street 2:SUITE A
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-2317
Practice Address - Country:US
Practice Address - Phone:601-824-3500
Practice Address - Fax:601-824-3501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3161-001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00660444Medicaid