DR. CONNOR MADISON LUTTRELL (NPI# 1114583580) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114583580 |
| Entity Type | Individual |
| Full Name | DR. CONNOR MADISON LUTTRELL |
| Credential | DDS |
| Practice Address |
350 Boatner Rd Eglin Afb FL 32542-1391 |
| Mailing Address |
58 3rd St Shalimar FL 32579-1747 |
| Practice Telephone | 8508838324 |
| Mailing Telephone | 8179758959 |
| Enumeration Date | 2019-05-11 |
| Last Update Date | 2020-09-09 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
35654 | TX | Dental Providers |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
350 BOATNER RD |
| City | EGLIN AFB |
| State | FL |
| Zip Code | 32542-1391 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063075414 | Christopher Lillenberg | Student in an Organized Health Care Education/Training Program | 350 Boatner Rd, Eglin Afb, FL 32542-1391 | 2019-04-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417440306 | Colt Sicher | Student in an Organized Health Care Education/Training Program | 96th Dental Squadron (afmc), Eglin Afb, Fl 32542, Apo, AA 32542 | 2018-06-14 |
| 1841679529 | Matthew Scurria | Dentist | 340 Boatner Rd. Bldg 2751, 96 Dental Squadron/sgdr, Eglin Afb, FL 32542 | 2015-05-27 |
| 1134518798 | 96th Medical Support Squadron | Military/U.S. Coast Guard Pharmacy | 3120 A. Talon Way, Eglin Afb Fld #3, FL 32542 | 2015-01-20 |
| 1598177123 | 96th Medical Support Squadron | Military/U.S. Coast Guard Pharmacy | 96 Medical Group Satellite Phcy Memorial Trail, Bldg. 1758, Eglin Afb, FL 32542 | 2014-06-02 |
| 1548602923 | Gerald Jordan Novack | Psychologist | 96mdos/sgow, 307 Boatner Rd, Fpo, AP 32542 | 2013-07-25 |
| 1699112821 | Taylor Anne Hahn | Obstetrics & Gynecology | 96th Medical Group, 307 Boatner Road, Eglin Air Force Base, FL 32542 | 2013-05-29 |
| 1730456948 | Nicholas Brandon Sager | Dentist | 340 Boatner Rd, Eglin Afb, Apo, AA 32542 | 2011-11-17 |
| 1134402662 | Jessamy Jae Thornton | Student in an Organized Health Care Education/Training Program | 340 Boatner Rd, Bldg 2751, Eglin Afb, FL 32542 | 2011-09-21 |
| 1346523974 | Mary Elizabeth Sorrentino | Dentist | 340 Boatner Road, Blgd. 2751, Eglin Afb, FL 32542 | 2011-09-20 |
| 1588945612 | Martin Army Community Hospital | Clinic/Center | 4327 North El Salvador Way, Eglin Afb, FL 32542 | 2011-09-02 |
| Find all providers in zip 32542 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346760113 | Nikkisha Mercado | Dentist | 340 Boatner Rd. Bldg 2751, 96 Dental Squadron/sgdr, Eglin Afb, FL 32542 | 2017-06-22 |
| 1346687373 | Lisa Darbonne Rackley | Dentist | 96th Medical Group, 307 Boatner Road, Eglin Afb, FL 32542 | 2013-05-31 |
| 1780931279 | Austin Evans | Dentist | 340 Boatner Road, Eglin Afb, FL 32542 | 2012-08-14 |
| 1225304041 | Ross K Oates | Dentist | 307 Boatner Rd Ste 114, Eglin Afb, FL 32542-1302 | 2012-03-26 |
| 1568558286 | Ashley Brooks | Dentist | 307 Boatner Road, Eglin Afb, FL 32542 | 2006-10-04 |
| 1699870311 | Adam Andrew Kuipers | Dentist | 307 Boatner Rd Ste 114, Eglin Afb, FL 32542-1302 | 2006-09-14 |
| 1467477174 | Robert Michael Garrett | Dentist | 307 Boatner Rd, Suite 114, Eglin Afb, FL 32542-1391 | 2006-07-13 |
| 1982669768 | Lance R Washburn | Dentist | 307 Boatner Rd Ste 114, Eglin Afb, FL 32542-1302 | 2006-04-17 |
| 1245294743 | Douglas John Ammon | Dentist | 307 Boatner Rd Ste 114, Eglin Afb, FL 32542-1302 | 2006-04-13 |
| 1588652655 | Rommie Glen Wheeler Sr. | Dentist | 307 Boatner Rd, Eglin Afb, FL 32542-1391 | 2005-10-12 |
| Find all providers in EGLIN AFB | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.