Healthcare Provider Details

I. General information

NPI: 1871645408
Provider Name (Legal Business Name): KEITH ALAN HUTCHINSON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 08/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2194 DREW STREET
CLEARWATER FL
33765-3214
US

IV. Provider business mailing address

2189 CLEVELAND ST SUITE 252
CLEARWATER FL
33765-3213
US

V. Phone/Fax

Practice location:
  • Phone: 727-462-5555
  • Fax: 727-446-8382
Mailing address:
  • Phone: 727-461-9149
  • Fax: 727-446-8382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN4592
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN14592
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: