Provider Demographics
NPI:1497820724
Name:HUTCHISON & GORMAN LLC
Entity Type:Organization
Organization Name:HUTCHISON & GORMAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HUTCHISON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-830-9110
Mailing Address - Street 1:14245 P CENTREVILLE SQ
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121
Mailing Address - Country:US
Mailing Address - Phone:703-830-9110
Mailing Address - Fax:703-830-1632
Practice Address - Street 1:14245P CENTREVILLE SQ
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2368
Practice Address - Country:US
Practice Address - Phone:703-830-9110
Practice Address - Fax:703-830-1632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010057541223G0001X
VA04014108931223G0001X
VA04010088611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6595510001Medicare NSC