Provider Demographics
NPI:1861529612
Name:HATCH, JEREMY D (DMD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:D
Last Name:HATCH
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 1:52 SOUTH 850 WEST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737
Mailing Address - Country:US
Mailing Address - Phone:435-635-9471
Mailing Address - Fax:435-635-9473
Practice Address - Street 1:52 SOUTH 850 WEST
Practice Address - Street 2:SUITE 201
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737
Practice Address - Country:US
Practice Address - Phone:435-635-9471
Practice Address - Fax:435-635-9473
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5657631-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice