Provider Demographics
NPI:1952382806
Name:TUTTLE, BRIAN LESLIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:LESLIE
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 1:2776 RINGGOLD ROAD
Mailing Address - Street 2:
Mailing Address - City:FT SILL
Mailing Address - State:OK
Mailing Address - Zip Code:73505
Mailing Address - Country:US
Mailing Address - Phone:580-442-5223
Mailing Address - Fax:580-442-4002
Practice Address - Street 1:2776 RINGGOLD ROAD
Practice Address - Street 2:
Practice Address - City:FT SILL
Practice Address - State:OK
Practice Address - Zip Code:73505
Practice Address - Country:US
Practice Address - Phone:580-442-5223
Practice Address - Fax:580-442-4002
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA083241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice