Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | M659 | SD |
N | 1223D0001X | Dental Public Health | M659 | SD |
N | 1223G0001X | General Practice | M659 | SD |
N | 213EG0000X | General Practice | M659 | SD |
NPI | 1376538462 |
---|---|
Provider Name | Dr. Gregory Duane Tuttle |
First Address | Madison, SD 57042-3721 |
Second Address | Desmet, SD 57231 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2005 |
Last Update Date | 08/07/2007 |