MEDICARE: HATCHER AND FREY ORTHODONTICS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1316410343
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HATCHER AND FREY ORTHODONTICS, LLC

Provider Business Mailing Address
First Line	:	3253 TAYLOR RD STE 100
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23321-2452
Country	:	US
Telephone Number	:	757-488-6080
Fax Number	:	757-488-6578

Provider Business Practice Location Address
First Line	:	3253 TAYLOR RD STE 100
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23321-2452
Country	:	US
Telephone Number	:	757-488-6080
Fax Number	:	757-488-6578

Authorized Official
Title or Position	:	ORTHODONTIST
Name	:	WILLIAM R HATCHER
Credential	:	D.D.S.
Telephone Number	:	757-488-6080

Provider Enumeration Date	:	01/02/2019
Last Update Date	:	01/02/2019

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