Provider Demographics
NPI:1316978158
Name:TUTTLE, ALBERT L (DDS, MS)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:L
Last Name:TUTTLE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 SHIPYARD BLVD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-8024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2250 SHIPYARD BLVD
Practice Address - Street 2:SUITE 11
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-8024
Practice Address - Country:US
Practice Address - Phone:910-392-6863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC53391223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics