Provider Demographics
NPI:1447726328
Name:HUTTULA, EMILY L (RDH)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:L
Last Name:HUTTULA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 N LACEY ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-5662
Mailing Address - Country:US
Mailing Address - Phone:095-935-6001
Mailing Address - Fax:
Practice Address - Street 1:105 N. SECOND STREET
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:WA
Practice Address - Zip Code:99173
Practice Address - Country:US
Practice Address - Phone:509-258-7543
Practice Address - Fax:509-258-7524
Is Sole Proprietor?:No
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH000007240124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPENDINGMedicaid