Healthcare Provider Details

I. General information

NPI: 1568569366
Provider Name (Legal Business Name): JOHN H HATFIELD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 SOUTH ST CAMDEN DENTISTRY LLC
CAMDEN DE
19934-1300
US

IV. Provider business mailing address

199 SOUTH ST CAMDEN DENTISTRY LLC
CAMDEN DE
19934-1300
US

V. Phone/Fax

Practice location:
  • Phone: 302-697-3125
  • Fax: 302-697-3640
Mailing address:
  • Phone: 302-697-3125
  • Fax: 302-697-3640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number949
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: