Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 19320 | MA |
NPI | 1164545968 |
---|---|
Provider Name | Dr. Jeffrey William Hutter |
First Address | Newton, MA 02459-3034 |
Second Address | Boston, MA 02215-1274 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2007 |
Last Update Date | 08/07/2007 |