Provider Demographics
NPI:1851416333
Name:HATTAR DENTAL PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:HATTAR DENTAL PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESEDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:HATTAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-255-3459
Mailing Address - Street 1:27409 COLDWATER DR
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-1865
Mailing Address - Country:US
Mailing Address - Phone:661-255-3459
Mailing Address - Fax:661-255-3459
Practice Address - Street 1:1319 N SAN FERNANDO BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-4236
Practice Address - Country:US
Practice Address - Phone:818-557-2299
Practice Address - Fax:818-557-8749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53599122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty