Healthcare Provider Details

I. General information

NPI: 1255908273
Provider Name (Legal Business Name): DR. JARED HATCH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 E MAIN ST
MONTROSE CO
81401-4043
US

IV. Provider business mailing address

3725 MOUNT HAYDEN CT
MONTROSE CO
81403-8139
US

V. Phone/Fax

Practice location:
  • Phone: 970-249-1543
  • Fax:
Mailing address:
  • Phone: 970-787-0393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number00204761
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number00204761
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: