Provider Demographics
NPI:1902928534
Name:HUTCHINSON, EBONY MA (DA)
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:MA
Last Name:HUTCHINSON
Suffix:
Gender:F
Credentials:DA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:486 FIRECREST AVE
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-1729
Mailing Address - Country:US
Mailing Address - Phone:415-956-6610
Mailing Address - Fax:415-956-6618
Practice Address - Street 1:450 SUTTER ST
Practice Address - Street 2:SUITE 2439
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4206
Practice Address - Country:US
Practice Address - Phone:415-956-6610
Practice Address - Fax:415-956-6618
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant