Provider Demographics
NPI:1548640568
Name:RICHARD W HUETTER DMD INC
Entity type:Organization
Organization Name:RICHARD W HUETTER DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HUETTER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:330-499-7997
Mailing Address - Street 1:1401 S MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-4289
Mailing Address - Country:US
Mailing Address - Phone:330-499-7997
Mailing Address - Fax:330-499-7680
Practice Address - Street 1:1401 S MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-4289
Practice Address - Country:US
Practice Address - Phone:330-499-7997
Practice Address - Fax:330-499-7680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH16284122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1619090081OtherPERSONAL NPI