Healthcare Provider Details

I. General information

NPI: 1144342619
Provider Name (Legal Business Name): JAY L HUTCHENS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1322 KLABZUBA AVE
PRAGUE OK
74864-4000
US

IV. Provider business mailing address

6917 NBU
PRAGUE OK
74864-4000
US

V. Phone/Fax

Practice location:
  • Phone: 405-567-4491
  • Fax: 405-567-2886
Mailing address:
  • Phone: 405-567-4491
  • Fax: 405-567-2886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3271
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: