Provider Demographics
NPI:1245313436
Name:JOE DAVID HUTCHISON, D.D.S., P.C.
Entity type:Organization
Organization Name:JOE DAVID HUTCHISON, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HUTCHISON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:573-547-6691
Mailing Address - Street 1:22 S WEST ST
Mailing Address - Street 2:
Mailing Address - City:PERRYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63775-2547
Mailing Address - Country:US
Mailing Address - Phone:573-768-9155
Mailing Address - Fax:
Practice Address - Street 1:22 S WEST ST
Practice Address - Street 2:
Practice Address - City:PERRYVILLE
Practice Address - State:MO
Practice Address - Zip Code:63775-2547
Practice Address - Country:US
Practice Address - Phone:573-547-6691
Practice Address - Fax:573-547-6691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO118451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
838501OtherUNITED CONCORDIA
15444OtherBLUECROSSBLUESHIELD OF MO