=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699884817
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILLIAM B HUTCHINS JR DDS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 202 E CHARLEMONT AVE
-----------------------------------------------------
City | KINGSPORT
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37660-4306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-245-3241
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 202 E CHARLEMONT AVE
-----------------------------------------------------
City | KINGSPORT
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37660-4306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-245-3241
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRES
-----------------------------------------------------
Name | WILLIAM B HUTCHINS JR JR.
-----------------------------------------------------
Credential | DDS PC
-----------------------------------------------------
Telephone | 423-245-3241
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DS002134
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------