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NPI Code Detail

MEDICARE: JESSICA HATALA DMD

MEDICARE: JESSICA HATALA DMD
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
11223G0001XGeneral Practice DentistryDS042331PA

General Provider Information

NPI Number : 1972128791
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA HATALA DMD
Provider Business Mailing Address
First Line : 1239 DUNDAFF ST
Second Line :
City : DICKSON CITY
State : PA
Zip : 18519-1142
Country : US
Telephone Number : 570-604-2611
Fax Number :
Provider Business Practice Location Address
First Line : 750 ROUTE 739
Second Line :
City : LORDS VALLEY
State : PA
Zip : 18428-6058
Country : US
Telephone Number : 570-775-7818
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2020
Last Update Date : 07/20/2020

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Directions to “ JESSICA HATALA DMD” Practice Location

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