Provider Demographics
NPI:1386978476
Name:NUTTLI, MARGARET ANN (DDS)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:ANN
Last Name:NUTTLI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 E 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-2814
Mailing Address - Country:US
Mailing Address - Phone:985-867-9122
Mailing Address - Fax:985-867-9169
Practice Address - Street 1:122 E 21ST AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-2814
Practice Address - Country:US
Practice Address - Phone:985-867-9122
Practice Address - Fax:985-867-9169
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4440122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist