Healthcare Provider Details

I. General information

NPI: 1295742617
Provider Name (Legal Business Name): PHILLIP EARL HUTCHESON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

5120 VIRGINIA WAY C-13
BRENTWOOD TN
37027-7515
US

IV. Provider business mailing address

5120 VIRGINIA WAY C-13
BRENTWOOD TN
37027-7515
US

V. Phone/Fax

Practice location:
  • Phone: 615-371-8888
  • Fax: 615-371-8894
Mailing address:
  • Phone: 615-371-8888
  • Fax: 615-371-8894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number2182
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: