| Richard Shad Hattaway, Dds, Pllc | |
|
1016 E Hebron Pkwy Ste. 170 Carrollton TX 75010-1022 | |
| (972) 836-8653 | |
| Not Available |
| Full Name | Richard Shad Hattaway, Dds, Pllc |
|---|---|
| Speciality | Dentist |
| Location | 1016 E Hebron Pkwy, Carrollton, Texas |
| Authorized Official Name and Position | Richard Shad Hattaway (OWNER) |
| Authorized Official Contact | 9728368653 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Richard Shad Hattaway, Dds, Pllc 1016 E Hebron Pkwy Ste. 170 Carrollton TX 75010-1022 Ph: (972) 836-8653 | Richard Shad Hattaway, Dds, Pllc 1016 E Hebron Pkwy Ste. 170 Carrollton TX 75010-1022 Ph: (972) 836-8653 |
| NPI Number | 1811422942 |
|---|---|
| Provider Enumeration Date | 04/26/2017 |
| Last Update Date | 04/26/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811422942 | NPI | - | NPPES |
| 1992149306 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 30158 (Texas) | Primary |
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