MEDICARE: DR. CLIFFORD ROSS HUTCHISON JR. D.D.S.

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	15049	TX

General Provider Information

NPI Number	:	1679686141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLIFFORD ROSS HUTCHISON JR. D.D.S.

Provider Business Mailing Address
First Line	:	6025 HARRIS PKWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4103
Country	:	US
Telephone Number	:	817-361-5620
Fax Number	:	817-361-7060

Provider Business Practice Location Address
First Line	:	6025 HARRIS PKWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4103
Country	:	US
Telephone Number	:	817-361-5620
Fax Number	:	817-361-7060

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	07/08/2007

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