Provider Demographics
NPI:1124098918
Name:JOHN D HATCH JR DDS PC
Entity type:Organization
Organization Name:JOHN D HATCH JR DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DEVER
Authorized Official - Last Name:HATCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-995-5791
Mailing Address - Street 1:1240 N MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-2842
Mailing Address - Country:US
Mailing Address - Phone:734-995-5191
Mailing Address - Fax:734-995-7079
Practice Address - Street 1:1240 N MAPLE RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-2842
Practice Address - Country:US
Practice Address - Phone:734-995-5191
Practice Address - Fax:734-995-7079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010104311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty