Healthcare Provider Details

I. General information

NPI: 1104898857
Provider Name (Legal Business Name): LARRY W. HUTCHINSON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5021 HAPPY CANYON RD
DENVER CO
80237-1036
US

IV. Provider business mailing address

5021 HAPPY CANYON RD
DENVER CO
80237-1036
US

V. Phone/Fax

Practice location:
  • Phone: 303-781-4511
  • Fax:
Mailing address:
  • Phone: 303-781-4511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number105390
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: