Provider Demographics
NPI:1770608176
Name:HUTHWAITE & HUTHWAITE FAMILY DENTISTRY
Entity type:Organization
Organization Name:HUTHWAITE & HUTHWAITE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:HUTHWAITE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-536-8868
Mailing Address - Street 1:452 S ENOTA DR NE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-2548
Mailing Address - Country:US
Mailing Address - Phone:770-536-8868
Mailing Address - Fax:770-536-8988
Practice Address - Street 1:452 S ENOTA DR NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2548
Practice Address - Country:US
Practice Address - Phone:770-536-8868
Practice Address - Fax:770-536-8988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA112531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty