Provider Demographics
NPI:1649680455
Name:TUFTON, PETER MICHAEL
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:MICHAEL
Last Name:TUFTON
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 1:654 TERRY PKWY
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-4306
Mailing Address - Country:US
Mailing Address - Phone:504-362-5270
Mailing Address - Fax:
Practice Address - Street 1:654 TERRY PKWY
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-4306
Practice Address - Country:US
Practice Address - Phone:504-362-5270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2231122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist