Provider Demographics
NPI:1780853911
Name:W. THOMAS HUTCHINS, JR. D.D.S., PA.
Entity Type:Organization
Organization Name:W. THOMAS HUTCHINS, JR. D.D.S., PA.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRESSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:STALLINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-876-8010
Mailing Address - Street 1:1307 E MILLBROOK RD
Mailing Address - Street 2:SUITE 108-C
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-5476
Mailing Address - Country:US
Mailing Address - Phone:919-876-8010
Mailing Address - Fax:919-876-1163
Practice Address - Street 1:1307 E MILLBROOK RD
Practice Address - Street 2:SUITE 108-C
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5476
Practice Address - Country:US
Practice Address - Phone:919-876-8010
Practice Address - Fax:919-876-1163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC37971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8994414Medicaid