Provider Demographics
NPI:1568956589
Name:HATFIELD DENTAL CLINIC PC
Entity Type:Organization
Organization Name:HATFIELD DENTAL CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HATFIELD
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:979-208-8638
Mailing Address - Street 1:220 W GUADALUPE ST
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:TX
Mailing Address - Zip Code:78945-1926
Mailing Address - Country:US
Mailing Address - Phone:979-208-8638
Mailing Address - Fax:979-272-4563
Practice Address - Street 1:220 W. GUADALUPE ST.
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945-1926
Practice Address - Country:US
Practice Address - Phone:979-208-8638
Practice Address - Fax:979-272-4563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-22
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13463261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
1649351875OtherNPI