Provider Demographics
NPI:1548334709
Name:MELISSA L. HUTCHENS DDS PA
Entity type:Organization
Organization Name:MELISSA L. HUTCHENS DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:LUND
Authorized Official - Last Name:HUTCHENS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-552-1616
Mailing Address - Street 1:538 MAIN ST S
Mailing Address - Street 2:SUITE 130
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:55008-1614
Mailing Address - Country:US
Mailing Address - Phone:763-552-1616
Mailing Address - Fax:763-552-1617
Practice Address - Street 1:538 MAIN ST S
Practice Address - Street 2:SUITE 130
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-1614
Practice Address - Country:US
Practice Address - Phone:763-552-1616
Practice Address - Fax:763-552-1617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND114181223G0001X
MND112731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty