Provider Demographics
NPI:1982739363
Name:OFFUTT, DAVID (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:OFFUTT
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 1:2247 N LOOP 336 W
Mailing Address - Street 2:SUITE A
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3520
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2247 N LOOP 336 W
Practice Address - Street 2:SUITE A
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3520
Practice Address - Country:US
Practice Address - Phone:936-756-0659
Practice Address - Fax:936-756-2244
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88221223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry