Healthcare Provider Details

I. General information

NPI: 1700401577
Provider Name (Legal Business Name): DAVID L HATCH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 VETERANS BLVD
FESTUS MO
63028-2329
US

IV. Provider business mailing address

1321 VETERANS BLVD
FESTUS MO
63028-2329
US

V. Phone/Fax

Practice location:
  • Phone: 636-931-4020
  • Fax:
Mailing address:
  • Phone: 636-931-4020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2020013626
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2020013626
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: