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General NPI Number Information
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NPI Number | 1831880517
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Entity Type | Individual
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Provider Name | PETER HATTAR DMD
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Gender | Male
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Dates
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Enumeration Date | 05/15/2023
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Last Update Date | 05/15/2023
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Provider Practice Location Address
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Address Line | 211 SWANSON AVE
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-0926
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Country | US
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Telephone | 928-854-8540
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Fax |
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Provider Business Mailing Address
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Address Line | 6508 EMMERTON LN
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City | HIGHLAND
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State | CA
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Zip | 92346-7759
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Country | US
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Telephone | 909-862-6402
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D011752
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License Number State | AZ
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