1619387503 NPI number — JENNA L. HATFIELD DDS PC

Table of content: (NPI 1619387503)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619387503 NPI number — JENNA L. HATFIELD DDS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JENNA L. HATFIELD DDS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619387503
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2501 LAKERIDGE DR
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
NORFOLK
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68701-2558
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-371-1170
Provider Business Mailing Address Fax Number:
402-644-3469

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2501 LAKERIDGE DR
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68701-2558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-371-1170
Provider Business Practice Location Address Fax Number:
402-644-3469
Provider Enumeration Date:
05/01/2014

Additional Information

Authorized Official

Authorized Official Last Name:
HATFIELD
Authorized Official First Name:
JENNA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
DENTIST/OWNER
Authorized Official Telephone Number:
402-371-1170

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  4752 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4752 . This is a "LICENSE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 122300000X . This is a "TAXONOMY" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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