MEDICARE: DR. GREGORY TODD HUTCHENS D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	0401007793	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	045494	OTHER	VA	BLUE CROSS (ANTHEM)

General Provider Information

NPI Number	:	1043308513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY TODD HUTCHENS D.D.S.

Provider Business Mailing Address
First Line	:	PO BOX 705
Second Line	:	112 E. BLUE RIDGE ST.
City	:	STUART
State	:	VA
Zip	:	24171-0705
Country	:	US
Telephone Number	:	276-694-3177
Fax Number	:	276-694-4439

Provider Business Practice Location Address
First Line	:	112 E. BLUE RIDGE ST.
Second Line	:
City	:	STUART
State	:	VA
Zip	:	24171-0705
Country	:	US
Telephone Number	:	276-694-3177
Fax Number	:	276-694-4439

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/08/2007

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