Active NPI
Mark Andrew Luttrell, D.D.S.
- Dentist
- Randolph, VT
National Provider Identifier
1316038268
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 989
- Practice address
- 58 S Pleasant St
Randolph, VT 05060-1365 - Phone
- (802) 728-3344
- NPI assigned
- Sep 27, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 989 | VT | Primary |
Addresses
Primary practice location
58 S Pleasant St
Randolph, VT 05060-1365
Mailing address
PO Box 425
Randolph, VT 05060-0425
Phone (802) 728-3344
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1002134 | Medicaid | VT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 989 | VT | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1316038268",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 425",
"city": "RANDOLPH",
"state": "VT",
"postal_code": "050600425",
"telephone_number": "802-728-3344"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "58 S PLEASANT ST",
"city": "RANDOLPH",
"state": "VT",
"postal_code": "050601365",
"telephone_number": "802-728-3344"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUTTRELL",
"first_name": "MARK",
"middle_name": "ANDREW",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "VT",
"license": "989",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1002134",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Randolph, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.