Provider Demographics
NPI:1093521379
Name:DUTTON DENTAL, LLC
Entity type:Organization
Organization Name:DUTTON DENTAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ETHAN
Authorized Official - Middle Name:CLAY
Authorized Official - Last Name:DUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-246-5344
Mailing Address - Street 1:115 RAINBOW DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-8224
Mailing Address - Country:US
Mailing Address - Phone:803-246-5344
Mailing Address - Fax:
Practice Address - Street 1:106 BOWDOCK DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35756-3995
Practice Address - Country:US
Practice Address - Phone:256-325-1290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-10
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental