Provider Demographics
NPI:1841701497
Name:TUTWILER, THEODORE YOUNG (DMD)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:YOUNG
Last Name:TUTWILER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2287 RALEIGH CT STE A
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-2061
Mailing Address - Country:US
Mailing Address - Phone:931-553-8484
Mailing Address - Fax:
Practice Address - Street 1:2287 RALEIGH CT STE A
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-2061
Practice Address - Country:US
Practice Address - Phone:931-553-8484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-21
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN115171223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics