Provider Demographics
NPI:1578813358
Name:HUTCHINSON FAMILY DENTISTRY, PA
Entity Type:Organization
Organization Name:HUTCHINSON FAMILY DENTISTRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BYRON
Authorized Official - Last Name:MACH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PHD
Authorized Official - Phone:320-587-2146
Mailing Address - Street 1:36 WASHINGTON AVE W
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-2440
Mailing Address - Country:US
Mailing Address - Phone:320-587-2146
Mailing Address - Fax:320-587-0720
Practice Address - Street 1:36 WASHINGTON AVE W
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-2440
Practice Address - Country:US
Practice Address - Phone:320-587-2146
Practice Address - Fax:320-587-0720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND122791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty