Provider Demographics
NPI:1780677435
Name:HITCHAN, JEFFREY R (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:R
Last Name:HITCHAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9130 MARSHALL RD.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CRANBERRY TWP.
Mailing Address - State:PA
Mailing Address - Zip Code:16066
Mailing Address - Country:US
Mailing Address - Phone:724-779-7999
Mailing Address - Fax:724-591-5391
Practice Address - Street 1:9130 MARSHALL RD.
Practice Address - Street 2:SUITE 200
Practice Address - City:CRANBERRY TWP.
Practice Address - State:PA
Practice Address - Zip Code:16066
Practice Address - Country:US
Practice Address - Phone:724-779-7999
Practice Address - Fax:724-591-5391
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0257251223S0112X
PADS025725-L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U32163Medicare UPIN
PA725488Medicare ID - Type Unspecified