Provider Demographics
NPI:1376430553
Name:STEPHEN HUTTON DMD PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:STEPHEN HUTTON DMD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:720-648-7752
Mailing Address - Street 1:850 PROSPECT ST STE 7
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4208
Mailing Address - Country:US
Mailing Address - Phone:858-459-7374
Mailing Address - Fax:
Practice Address - Street 1:850 PROSPECT ST STE 7
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4208
Practice Address - Country:US
Practice Address - Phone:858-459-7374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty