Provider Demographics
NPI:1043308513
Name:HUTCHENS, GREGORY TODD (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:TODD
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:PO BOX 705
Mailing Address - Street 2:112 E. BLUE RIDGE ST.
Mailing Address - City:STUART
Mailing Address - State:VA
Mailing Address - Zip Code:24171-0705
Mailing Address - Country:US
Mailing Address - Phone:276-694-3177
Mailing Address - Fax:276-694-4439
Practice Address - Street 1:112 E. BLUE RIDGE ST.
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:VA
Practice Address - Zip Code:24171-0705
Practice Address - Country:US
Practice Address - Phone:276-694-3177
Practice Address - Fax:276-694-4439
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010077931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA045494OtherBLUE CROSS (ANTHEM)