MEDICARE: JOHN D. HUTCHINSON ENTERPRISES, INC.

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
1	1223G0001X	General Practice Dentistry	DN0012330	FL

General Provider Information

NPI Number	:	1619198736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN D. HUTCHINSON ENTERPRISES, INC.

Provider Business Mailing Address
First Line	:	816 PINEDALE RD
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-2484
Country	:	US
Telephone Number	:	850-862-0047
Fax Number	:	850-862-4204

Provider Business Practice Location Address
First Line	:	816 PINEDALE RD
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-2484
Country	:	US
Telephone Number	:	850-862-0047
Fax Number	:	850-862-4204

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. JOHN D. HUTCHINSON
Credential	:	DDS
Telephone Number	:	850-862-0047

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	08/22/2020

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