Provider Demographics
NPI:1679855852
Name:J.MICHAEL HATCHETT, DDS, PC MARK ALLAN THOMPSON, DDS, PC
Entity Type:Organization
Organization Name:J.MICHAEL HATCHETT, DDS, PC MARK ALLAN THOMPSON, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-586-6829
Mailing Address - Street 1:408 WYNN DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75766-4976
Mailing Address - Country:US
Mailing Address - Phone:903-586-6829
Mailing Address - Fax:903-589-6801
Practice Address - Street 1:408 WYNN DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-4976
Practice Address - Country:US
Practice Address - Phone:903-586-6829
Practice Address - Fax:903-589-6801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12843122300000X
TX12913122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1457458960OtherINDIVIDUAL NPI
TX008650601Medicaid
TX008274501Medicaid
TX1881776912OtherINDIVIDUAL NPI