Provider Demographics
NPI:1144342619
Name:HUTCHENS, JAY L (DDS)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:L
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 1:6917 NBU
Mailing Address - Street 2:
Mailing Address - City:PRAGUE
Mailing Address - State:OK
Mailing Address - Zip Code:74864-4000
Mailing Address - Country:US
Mailing Address - Phone:405-567-4491
Mailing Address - Fax:405-567-2886
Practice Address - Street 1:1322 KLABZUBA AVE
Practice Address - Street 2:
Practice Address - City:PRAGUE
Practice Address - State:OK
Practice Address - Zip Code:74864-4000
Practice Address - Country:US
Practice Address - Phone:405-567-4491
Practice Address - Fax:405-567-2886
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3271122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist