Provider Demographics
NPI:1912087164
Name:HATT, HOLLY D (DMD, MD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:D
Last Name:HATT
Suffix:
Gender:F
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15725 POMERADO RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2068
Mailing Address - Country:US
Mailing Address - Phone:858-451-0200
Mailing Address - Fax:858-451-0250
Practice Address - Street 1:15725 POMERADO RD
Practice Address - Street 2:SUITE 205
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2068
Practice Address - Country:US
Practice Address - Phone:858-451-0200
Practice Address - Fax:858-451-0250
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91989174400000X
CA533451223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No174400000XOther Service ProvidersSpecialist