Provider Demographics
NPI:1093722621
Name:HATCHER, COLLIN RAYMOND (DDS)
Entity Type:Individual
Prefix:
First Name:COLLIN
Middle Name:RAYMOND
Last Name:HATCHER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2127 CLIFF RD
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2301
Mailing Address - Country:US
Mailing Address - Phone:651-454-9028
Mailing Address - Fax:
Practice Address - Street 1:2127 CLIFF RD
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2301
Practice Address - Country:US
Practice Address - Phone:651-454-9028
Practice Address - Fax:651-454-6212
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN92231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN23459HAOtherBLUE CROSS BLUE SHIELD
MN429140OtherUNITED CONCORDIA