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Individual

DR. MARK ANDREW LUTTRELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.D.S.

Contact information

Practice address
58 S PLEASANT ST, RANDOLPH, VT 05060-1365
(802) 728-3344
Mailing address
PO BOX 425, RANDOLPH, VT 05060-0425
(802) 728-3344

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
989
VT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1002134
VT
Enumeration date
09/27/2006
Last updated
07/08/2007
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