Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | G3-0000322 | DE |
NPI | 1083747018 |
---|---|
Provider Name | Dr. Michael D Tuttle |
First Address | Newark, DE 19713-2881 |
Second Address | Wilmington, DE 19801-1013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2007 |
Last Update Date | 08/07/2007 |