Provider Demographics
NPI:1629163498
Name:MCCORKLE, HUTSON EDWIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:HUTSON
Middle Name:EDWIN
Last Name:MCCORKLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 DELANEY AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-3825
Mailing Address - Country:US
Mailing Address - Phone:407-422-3131
Mailing Address - Fax:407-422-3134
Practice Address - Street 1:605 DELANEY AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-3825
Practice Address - Country:US
Practice Address - Phone:407-422-3131
Practice Address - Fax:407-422-3134
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN3809122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist