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NPI Code Detail

MEDICARE: JOE DAVID HUTCHISON, D.D.S., P.C.

MEDICARE: JOE DAVID HUTCHISON, D.D.S., P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry11845MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1838501OTHERUNITED CONCORDIA
215444OTHERBLUECROSSBLUESHIELD OF MO

General Provider Information

NPI Number : 1245313436
Entity Type Code : Organization
Provider Name (Legal Business Name) : JOE DAVID HUTCHISON, D.D.S., P.C.
Provider Business Mailing Address
First Line : 22 S WEST ST
Second Line :
City : PERRYVILLE
State : MO
Zip : 63775-2547
Country : US
Telephone Number : 573-768-9155
Fax Number :
Provider Business Practice Location Address
First Line : 22 S WEST ST
Second Line :
City : PERRYVILLE
State : MO
Zip : 63775-2547
Country : US
Telephone Number : 573-547-6691
Fax Number : 573-547-6691
Authorized Official
Title or Position : OWNER/DENTIST
Name : DR. JOSEPH DAVID HUTCHISON
Credential : D.D.S.
Telephone Number : 573-547-6691
Provider Enumeration Date : 10/23/2006
Last Update Date : 08/22/2020

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