Individual
DR. GREGORY P HATZIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., D.D.S.
Contact information
Practice address
110 BERGEN ST, RM B854, NEWARK, NJ 07103-2495
(973) 972-2444
(973) 972-3689
Mailing address
110 BERGEN ST, RM B854, NEWARK, NJ 07103-2495
(973) 972-2444
(973) 972-3689
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
22DI02319600
NJ
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
23172
TX
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
L9730
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
191226305
MEDICAID (DENTAL)
TX
Enumeration date
09/14/2006
Last updated
07/09/2016
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