Provider Demographics
NPI:1740261403
Name:HATCHER, DJ (DDS)
Entity type:Individual
Prefix:DR
First Name:DJ
Middle Name:
Last Name:HATCHER
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 1:449 MEADOWLARK ST
Mailing Address - Street 2:
Mailing Address - City:SHAW A F B
Mailing Address - State:SC
Mailing Address - Zip Code:29152-5020
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:449 MEADOWLARK ST
Practice Address - Street 2:
Practice Address - City:SHAW A F B
Practice Address - State:SC
Practice Address - Zip Code:29152-5020
Practice Address - Country:US
Practice Address - Phone:803-895-6108
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0034231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice