Provider Demographics
NPI:1013324102
Name:HATZKE, MATTHEW WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:WILLIAM
Last Name:HATZKE
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 1:1300 W LODI AVE STE N
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-3038
Mailing Address - Country:US
Mailing Address - Phone:209-368-1909
Mailing Address - Fax:209-368-0376
Practice Address - Street 1:1300 W LODI AVE STE N
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-3038
Practice Address - Country:US
Practice Address - Phone:209-368-1909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63671122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist