Provider Demographics
NPI:1780091496
Name:HUTCHISON, MIRANDA (DDS)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:HUTCHISON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14001 E ILIFF AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1424
Mailing Address - Country:US
Mailing Address - Phone:303-519-9995
Mailing Address - Fax:
Practice Address - Street 1:14001 E ILIFF AVE STE 104
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1424
Practice Address - Country:US
Practice Address - Phone:303-337-0047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-14
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2022441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice