Healthcare Provider Details

I. General information

NPI: 1861931149
Provider Name (Legal Business Name): KRISTIN ANN HUTKIN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2017
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 E PRENTICE AVE 3A
GREENWOOD VILLAGE CO
80111
US

IV. Provider business mailing address

14618 MOORPARK ST APT C
SHERMAN OAKS CA
91403
US

V. Phone/Fax

Practice location:
  • Phone: 720-459-5517
  • Fax:
Mailing address:
  • Phone: 302-373-9298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDEN.00205035
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDDS106266
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: