Healthcare Provider Details

I. General information

NPI: 1306816012
Provider Name (Legal Business Name): JEFFREY DAVID HUTCHESON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8430 UNIVERSITY EXEC PARK DR SUITE 600
CHARLOTTE NC
28262-3379
US

IV. Provider business mailing address

8430 UNIVERSITY EXEC PARK DR SUITE 600
CHARLOTTE NC
28262-3379
US

V. Phone/Fax

Practice location:
  • Phone: 704-548-1100
  • Fax: 704-549-1455
Mailing address:
  • Phone: 704-548-1100
  • Fax: 704-549-1455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number6144
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number4385
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: