Provider Demographics
NPI:1558528554
Name:HATFIELD, CRISTIE D (DENTAL HYGENTIST)
Entity Type:Individual
Prefix:
First Name:CRISTIE
Middle Name:D
Last Name:HATFIELD
Suffix:
Gender:F
Credentials:DENTAL HYGENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ROUTE 103 SUPPLY ST PO BOX 507
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:WV
Mailing Address - Zip Code:24836
Mailing Address - Country:US
Mailing Address - Phone:304-448-2101
Mailing Address - Fax:304-448-3217
Practice Address - Street 1:ROUTE 103 SUPPLY ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:WV
Practice Address - Zip Code:24836
Practice Address - Country:US
Practice Address - Phone:304-448-2101
Practice Address - Fax:304-448-3217
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2770124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist