Vincent Miles Lutterbie, DDS
Individual provider Active NPI Dentist · Marshall, MO
NPI 1003929969 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1003929969
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 0013387 (MO)
- Practice address
- Lincoln and Slater Streets
Marshall, MO 65340 - Phone
- (660) 886-2202
- Fax
- (660) 886-3047
- NPI assigned
- Aug 16, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0013387 | MO | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 0013387 | MO | Yes |
Addresses
Primary practice location
Lincoln and Slater Streets
Marshall, MO 65340
Mailing address
PO Box 190
Marshall, MO 65340
Phone (660) 886-2202
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8140613 | Other | CPIN |
Other providers in Marshall, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.