Healthcare Provider Details

I. General information

NPI: 1801860010
Provider Name (Legal Business Name): CARL F. HUTCHERSON DMD, FAGD, MAAFO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 MEADOW SPRING RD
GREENSBURG PA
15601-6935
US

IV. Provider business mailing address

105 MEADOW SPRING RD
GREENSBURG PA
15601-6935
US

V. Phone/Fax

Practice location:
  • Phone: 724-832-1835
  • Fax: 724-832-1836
Mailing address:
  • Phone: 724-832-1835
  • Fax: 724-832-1836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS020694L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: