Provider Demographics
NPI:1154587673
Name:HUTCHISON, JOSEPH DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:DAVID
Last Name:HUTCHISON
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 1:22 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:573-547-6691
Mailing Address - Fax:573-547-6691
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
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO118451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
838501OtherUNITED CONCORDIA
15444OtherBLUE CROSS BLUE SHIELD MO
MO400315206Medicaid