Healthcare Provider Details

I. General information

NPI: 1558528554
Provider Name (Legal Business Name): CRISTIE D HATFIELD DENTAL HYGENTIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROUTE 103 SUPPLY ST
GARY WV
24836
US

IV. Provider business mailing address

ROUTE 103 SUPPLY ST PO BOX 507
GARY WV
24836
US

V. Phone/Fax

Practice location:
  • Phone: 304-448-2101
  • Fax: 304-448-3217
Mailing address:
  • Phone: 304-448-2101
  • Fax: 304-448-3217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2770
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: