Healthcare Provider Details

I. General information

NPI: 1275103392
Provider Name (Legal Business Name): JOURNEE HUTCHCROFT DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 JOSEPH ST
DODGEVILLE WI
53533-9664
US

IV. Provider business mailing address

1208 JOSEPH ST
DODGEVILLE WI
53533-9664
US

V. Phone/Fax

Practice location:
  • Phone: 608-935-5262
  • Fax:
Mailing address:
  • Phone: 608-935-5265
  • Fax: 608-930-5265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1002614-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: