Provider Demographics
NPI:1184912610
Name:REBECCA L. HATFIELD-MOSIER
Entity type:Organization
Organization Name:REBECCA L. HATFIELD-MOSIER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:HATFIELD
Authorized Official - Last Name:CARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:423-949-2117
Mailing Address - Street 1:P.O. BOX 519
Mailing Address - Street 2:7268 STATE ROUTE 28
Mailing Address - City:DUNLAP
Mailing Address - State:TN
Mailing Address - Zip Code:37327
Mailing Address - Country:US
Mailing Address - Phone:423-949-2117
Mailing Address - Fax:423-949-3011
Practice Address - Street 1:7268 STATE ROUTE 28
Practice Address - Street 2:
Practice Address - City:DUNLAP
Practice Address - State:TN
Practice Address - Zip Code:37327
Practice Address - Country:US
Practice Address - Phone:423-949-2117
Practice Address - Fax:423-949-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN005232122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3225742Medicaid