Healthcare Provider Details

I. General information

NPI: 1720121791
Provider Name (Legal Business Name): LUTHER HILL HUTCHENS JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 DOCTORS DR STE N
JACKSONVILLE NC
28546-6308
US

IV. Provider business mailing address

544 FIDDLER'S RIDGE DR.
ATLANTIC BEACH NC
28512
US

V. Phone/Fax

Practice location:
  • Phone: 910-577-1315
  • Fax: 910-577-1078
Mailing address:
  • Phone: 252-247-5708
  • Fax: 252-247-5708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number3119
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: