Provider Demographics
NPI:1144200643
Name:HUTNIK, GARY PETER (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:PETER
Last Name:HUTNIK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 ROWE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48875-1645
Mailing Address - Country:US
Mailing Address - Phone:517-647-6205
Mailing Address - Fax:517-647-5374
Practice Address - Street 1:155 ROWE AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:MI
Practice Address - Zip Code:48875-1645
Practice Address - Country:US
Practice Address - Phone:517-647-6205
Practice Address - Fax:517-647-5374
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI13468122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist