Healthcare Provider Details

I. General information

NPI: 1629568019
Provider Name (Legal Business Name): DREW HUTINGER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3608 FARAON ST
SAINT JOSEPH MO
64506-3044
US

IV. Provider business mailing address

2303 VILLAGE DR
SAINT JOSEPH MO
64506-4954
US

V. Phone/Fax

Practice location:
  • Phone: 816-232-4417
  • Fax: 816-671-0961
Mailing address:
  • Phone: 816-271-8219
  • Fax: 816-232-2991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2017017280
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: