Provider Demographics
NPI:1699863415
Name:CANDICE HUTCHESON, D.D.S., M.S., PLLC
Entity type:Organization
Organization Name:CANDICE HUTCHESON, D.D.S., M.S., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:ZERBY
Authorized Official - Last Name:HUTCHESON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:972-235-8555
Mailing Address - Street 1:100 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 1108
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-5332
Mailing Address - Country:US
Mailing Address - Phone:972-235-8555
Mailing Address - Fax:972-235-3148
Practice Address - Street 1:100 N CENTRAL EXPY
Practice Address - Street 2:SUITE 1108
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5332
Practice Address - Country:US
Practice Address - Phone:972-235-8555
Practice Address - Fax:972-235-3148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113881223P0221X
TX238431223P0221X
TX196811223X0400X
1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX091017604Medicaid