Provider Demographics
NPI:1477093094
Name:BRIAN K HATCH, DMD PC
Entity Type:Organization
Organization Name:BRIAN K HATCH, DMD PC
Other - Org Name:MOUNTAIN VIEW PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:
Authorized Official - Last Name:WHARTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-892-9893
Mailing Address - Street 1:1904 WELLSPRING AVE SE
Mailing Address - Street 2:#105
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-4888
Mailing Address - Country:US
Mailing Address - Phone:505-415-0462
Mailing Address - Fax:
Practice Address - Street 1:1904 WELLSPRING AVE SE
Practice Address - Street 2:#105
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-4888
Practice Address - Country:US
Practice Address - Phone:505-415-0462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD45991223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty