Provider Demographics
NPI:1679686141
Name:HUTCHISON, CLIFFORD ROSS JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:ROSS
Last Name:HUTCHISON
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:BUTCH
Other - Middle Name:
Other - Last Name:HUTCHISON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:6025 HARRIS PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4103
Mailing Address - Country:US
Mailing Address - Phone:817-361-5620
Mailing Address - Fax:817-361-7060
Practice Address - Street 1:6025 HARRIS PKWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4103
Practice Address - Country:US
Practice Address - Phone:817-361-5620
Practice Address - Fax:817-361-7060
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX150491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice