MEDICARE: HUTSON E. MCCORKLE, D.D.S.,P.A.

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

General Provider Information

NPI Number	:	1699860429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUTSON E. MCCORKLE, D.D.S.,P.A.

Provider Business Mailing Address
First Line	:	605 DELANEY AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32801-3825
Country	:	US
Telephone Number	:	407-422-3131
Fax Number	:	407-422-3134

Provider Business Practice Location Address
First Line	:	605 DELANEY AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32801-3825
Country	:	US
Telephone Number	:	407-422-3131
Fax Number	:	407-422-3134

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HUTSON EDWIN MCCORKLE
Credential	:	D.D.S.
Telephone Number	:	407-422-3131

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	08/22/2020

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