Provider Demographics
NPI:1508201450
Name:HATCH, JOHN DEVER JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DEVER
Last Name:HATCH
Suffix:JR
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 1:1240 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
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901010431122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist