Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 5599 | AL |
N | 1223E0200X | Endodontist | DS7698 | TN |
NPI | 1114906187 |
---|---|
Provider Name | Andrew Scott Huttula |
First Address | Huntsville, AL 35801-6097 |
Second Address | Huntsville, AL 35801-6446 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2006 |
Last Update Date | 22/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000OTH | (02) |