Provider Demographics
NPI:1518079706
Name:HATCH, DAVID SIDNEY (DMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:SIDNEY
Last Name:HATCH
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 1:8410 SW CURRY DR
Mailing Address - Street 2:UNIT C
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-7885
Mailing Address - Country:US
Mailing Address - Phone:503-694-1077
Mailing Address - Fax:503-375-5737
Practice Address - Street 1:2300 LANCASTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1223
Practice Address - Country:US
Practice Address - Phone:503-370-4843
Practice Address - Fax:503-375-5737
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR55121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice