Provider Demographics
NPI:1265975510
Name:TRIAD DENTISTRY
Entity type:Organization
Organization Name:TRIAD DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-383-1482
Mailing Address - Street 1:2516 OAKCREST AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-1933
Mailing Address - Country:US
Mailing Address - Phone:336-383-1482
Mailing Address - Fax:336-282-2437
Practice Address - Street 1:2516 OAKCREST AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-1933
Practice Address - Country:US
Practice Address - Phone:336-282-4022
Practice Address - Fax:336-282-2437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-18
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
NC7439122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty