Provider Demographics
NPI:1760895841
Name:HATFIELD, JENNA L (DDS)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:L
Last Name:HATFIELD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 LAKERIDGE DR
Mailing Address - Street 2:ST 102
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-2558
Mailing Address - Country:US
Mailing Address - Phone:402-371-1170
Mailing Address - Fax:
Practice Address - Street 1:2501 LAKERIDGE DR
Practice Address - Street 2:ST 102
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-2558
Practice Address - Country:US
Practice Address - Phone:402-371-1170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE71601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice