| |
1970 W Boulevard Kokomo IN 46902-6078 | |
(765) 868-2222 | |
(765) 868-8119 |
Full Name | |
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Speciality | Dentist |
Location | 1970 W Boulevard, Kokomo, Indiana |
Authorized Official Name and Position | Michael Tuttle (OWNER) |
Authorized Official Contact | 7658682222 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1970 W Boulevard Kokomo IN 46902-6078 Ph: (765) 868-2222 | 1970 W Boulevard Kokomo IN 46902-6078 Ph: (765) 868-2222 |
NPI Number | 1780833194 |
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Provider Enumeration Date | 09/10/2008 |
Last Update Date | 10/21/2008 |
Medicare PECOS PAC ID | 9234297102 |
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Medicare Enrollment ID | O20081021000688 |
Identifier | Type | State | Issuer |
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1780833194 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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1223S0112X | Dentist - Oral And Maxillofacial Surgery | 12010567 (Indiana) | Primary |
Provider Name | Michael D Tuttle |
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Provider Type | Practitioner - Oral Surgery |
Provider Identifiers | NPI Number: 1083747018 PECOS PAC ID: 9931283561 Enrollment ID: I20080221000069 |
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Howard County Oral And Maxillofacial Surgeons Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1970 W Boulevard, Kokomo, IN 46902 Phone: 765-868-2222 Fax: 765-868-8119 | |
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