Provider Demographics
NPI:1831880517
Name:HATTAR, PETER (DMD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:HATTAR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6508 EMMERTON LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-7759
Mailing Address - Country:US
Mailing Address - Phone:909-862-6402
Mailing Address - Fax:
Practice Address - Street 1:211 SWANSON AVE
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-0926
Practice Address - Country:US
Practice Address - Phone:928-854-8540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD011752122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist