Healthcare Provider Details

I. General information

NPI: 1932364841
Provider Name (Legal Business Name): ALLEN ROBERT HUTCHINS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 10/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16B FELTON PL
CARTERSVILLE GA
30120-2152
US

IV. Provider business mailing address

1350 SPRING STREET 6TH FLOOR
ATLANTA GA
30144-2870
US

V. Phone/Fax

Practice location:
  • Phone: 770-382-3536
  • Fax: 770-382-1915
Mailing address:
  • Phone: 404-389-1950
  • Fax: 678-444-4152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN008876
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number4033
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number3168
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0017422
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2901012439
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: