Provider Demographics
NPI:1053974196
Name:BRIAN K. HUTTO, DMD, INC.
Entity type:Organization
Organization Name:BRIAN K. HUTTO, DMD, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:HUTTO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:209-522-5238
Mailing Address - Street 1:1213 COFFEE RD STE D
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-4229
Mailing Address - Country:US
Mailing Address - Phone:209-522-5238
Mailing Address - Fax:
Practice Address - Street 1:2301 ST PAULS WAY
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3309
Practice Address - Country:US
Practice Address - Phone:209-522-5238
Practice Address - Fax:209-522-4703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-15
Last Update Date:2024-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery