Provider Demographics
NPI:1972890226
Name:HUTCHENS, GRANT TYLER (DDS)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:TYLER
Last Name:HUTCHENS
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 1:7900 EL CAJON BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-0607
Mailing Address - Country:US
Mailing Address - Phone:619-465-1733
Mailing Address - Fax:
Practice Address - Street 1:7900 EL CAJON BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-0607
Practice Address - Country:US
Practice Address - Phone:619-465-1733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2013-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412917122300000X
CA612151223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist