Provider Demographics
NPI:1720240500
Name:HATCHER, CAMILLE REYNAUD (RDH)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:REYNAUD
Last Name:HATCHER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1136
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:MO
Mailing Address - Zip Code:64831-1136
Mailing Address - Country:US
Mailing Address - Phone:417-845-2243
Mailing Address - Fax:
Practice Address - Street 1:508 W 76 HIGHWAY
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:MO
Practice Address - Zip Code:64831
Practice Address - Country:US
Practice Address - Phone:417-845-2243
Practice Address - Fax:417-845-3942
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000740124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist