Provider Demographics
NPI:1902184211
Name:HATCH, JASON BRUCE
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:BRUCE
Last Name:HATCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-3638
Mailing Address - Country:US
Mailing Address - Phone:620-665-5582
Mailing Address - Fax:620-665-6073
Practice Address - Street 1:2411 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-3638
Practice Address - Country:US
Practice Address - Phone:620-665-5582
Practice Address - Fax:620-665-6073
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6093122300000X
KS61233122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist