Healthcare Provider Details

I. General information

NPI: 1790161081
Provider Name (Legal Business Name): JORDAN HATCH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N DOBSON RD UNIT 16
CHANDLER AZ
85224-6973
US

IV. Provider business mailing address

700 N DOBSON RD UNIT 16
CHANDLER AZ
85224-6973
US

V. Phone/Fax

Practice location:
  • Phone: 480-310-8693
  • Fax:
Mailing address:
  • Phone: 480-310-8693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License NumberD009299
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: