Provider Demographics
NPI:1760509012
Name:HUTCHISON, KAREN L (DMD)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:L
Last Name:HUTCHISON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 CAROLINA AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-2310
Mailing Address - Country:US
Mailing Address - Phone:540-400-7075
Mailing Address - Fax:
Practice Address - Street 1:4572 FRANKLIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-5144
Practice Address - Country:US
Practice Address - Phone:540-769-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014109281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA247304OtherANTHEM PROVIDER NUMBER
VA1634693OtherUNITED CONCORDIA PROVIDER