Provider Demographics
NPI:1497766091
Name:HATCHER, MICHAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:HATCHER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 E BLANCO RD
Mailing Address - Street 2:16
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-1886
Mailing Address - Country:US
Mailing Address - Phone:830-249-9300
Mailing Address - Fax:830-249-9330
Practice Address - Street 1:1415 E BLANCO RD STE 16
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-1887
Practice Address - Country:US
Practice Address - Phone:830-249-9300
Practice Address - Fax:830-249-9330
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23063122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist