Healthcare Provider Details

I. General information

NPI: 1407657497
Provider Name (Legal Business Name): SHELBY HATCHETT DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 E 11TH ST
PANAMA CITY FL
32401-3409
US

IV. Provider business mailing address

420 CHURCHWELL DR UNIT 9121
PANAMA CITY BEACH FL
32407-3823
US

V. Phone/Fax

Practice location:
  • Phone: 850-767-3350
  • Fax:
Mailing address:
  • Phone: 731-394-4564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN30287
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: