Provider Demographics
NPI:1548524390
Name:TUTWILER, STRUDWICK LOUIS (DMD, MS)
Entity type:Individual
Prefix:
First Name:STRUDWICK
Middle Name:LOUIS
Last Name:TUTWILER
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 532
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37815
Mailing Address - Country:US
Mailing Address - Phone:423-621-2000
Mailing Address - Fax:423-621-2001
Practice Address - Street 1:2729 W ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3215
Practice Address - Country:US
Practice Address - Phone:423-621-2000
Practice Address - Fax:423-621-2001
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000109161223E0200X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes1223E0200XDental ProvidersDentistEndodontics