Provider Demographics
NPI:1780764993
Name:HATCHER AND BOMSTAD DDS LLC
Entity type:Organization
Organization Name:HATCHER AND BOMSTAD DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-938-7746
Mailing Address - Street 1:911 FIRST ST NORTH
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-7526
Mailing Address - Country:US
Mailing Address - Phone:952-938-7746
Mailing Address - Fax:952-938-1511
Practice Address - Street 1:911 FIRST ST NORTH
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-7526
Practice Address - Country:US
Practice Address - Phone:952-938-7746
Practice Address - Fax:952-938-1511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty