Provider Demographics
NPI:1528174695
Name:HUTTO, DAVID R (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:HUTTO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 PARK ST
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-4880
Mailing Address - Country:US
Mailing Address - Phone:803-536-9300
Mailing Address - Fax:803-536-6922
Practice Address - Street 1:1380 PARK ST
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-4880
Practice Address - Country:US
Practice Address - Phone:803-536-9300
Practice Address - Fax:803-536-6922
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2074122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ27043Medicaid