Provider Demographics
NPI:1962605865
Name:TUTT, LEA ANN (DENTAL HYGIENIST)
Entity type:Individual
Prefix:MS
First Name:LEA
Middle Name:ANN
Last Name:TUTT
Suffix:
Gender:F
Credentials:DENTAL HYGIENIST
Other - Prefix:MS
Other - First Name:LEA
Other - Middle Name:ANN
Other - Last Name:WOODARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DENTAL HYGIENIST
Mailing Address - Street 1:647 COWBOYS PKWY
Mailing Address - Street 2:2060
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-5403
Mailing Address - Country:US
Mailing Address - Phone:214-701-6113
Mailing Address - Fax:
Practice Address - Street 1:120 S DENTON TAP RD
Practice Address - Street 2:210
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-3297
Practice Address - Country:US
Practice Address - Phone:972-393-7348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7086124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist