Provider Demographics
NPI:1205870284
Name:HUTCHINSON, KENNETH KIRBY (D,MD, FAGD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:KIRBY
Last Name:HUTCHINSON
Suffix:
Gender:M
Credentials:D,MD, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1569-A JANMAR RD.
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-5780
Mailing Address - Country:US
Mailing Address - Phone:770-979-7923
Mailing Address - Fax:678-990-6954
Practice Address - Street 1:1569-A JANMAR RD.
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-5780
Practice Address - Country:US
Practice Address - Phone:770-979-7923
Practice Address - Fax:678-990-6954
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA96401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice