Healthcare Provider Details

I. General information

NPI: 1164986469
Provider Name (Legal Business Name): HUTCHINSON ORTHODONTICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2019
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 COMPOUND DR
HUTCHINSON KS
67502-4300
US

IV. Provider business mailing address

308 N HARRISON AVE
SEDGWICK KS
67135-9477
US

V. Phone/Fax

Practice location:
  • Phone: 316-652-5321
  • Fax:
Mailing address:
  • Phone: 316-652-5321
  • Fax: 316-722-1371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: LEVI HANSEN
Title or Position: PRESIDENT
Credential: DMD, MS
Phone: 316-652-5321