Provider Demographics
NPI:1669683058
Name:HATCH, ANTHONY EDWIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:EDWIN
Last Name:HATCH
Suffix:
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 1:11656 SILVER RIDGE PT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-2320
Mailing Address - Country:US
Mailing Address - Phone:858-531-4964
Mailing Address - Fax:858-530-0307
Practice Address - Street 1:10672 WEXFORD STREET
Practice Address - Street 2:SUITE 220
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131
Practice Address - Country:US
Practice Address - Phone:858-530-0300
Practice Address - Fax:858-530-0307
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55750122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist