Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 DELANEY AVE
ORLANDO FL
32801-3825
US

IV. Provider business mailing address

605 DELANEY AVE
ORLANDO FL
32801-3825
US

V. Phone/Fax

Practice location:
  • Phone: 407-422-3131
  • Fax: 407-422-3134
Mailing address:
  • Phone: 407-422-3131
  • Fax: 407-422-3134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. HUTSON EDWIN MCCORKLE
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 407-422-3131