Healthcare Provider Details

I. General information

NPI: 1053334540
Provider Name (Legal Business Name): GINA HITCHCOCK DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2436 FOOTHILL BLVD STE A
CALISTOGA CA
94515-1209
US

IV. Provider business mailing address

1543 KEARNEY ST
SAINT HELENA CA
94574-1824
US

V. Phone/Fax

Practice location:
  • Phone: 707-942-5177
  • Fax:
Mailing address:
  • Phone: 707-967-8456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number43283
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: