Jennifer Ann Hathaway, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

17025 Issued in TX

Practice address

1719 Broadmoor Dr
Bryan, TX 77802-5210

Phone

(979) 776-6884

Fax

(979) 774-3008

NPI assigned

Jun 14, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jennifer a Hathaway DDS PA

  • Customized Equipment (DME)
  • Bryan, TX
  • NPI 1972139764
  NPD
• Texas Dental Sleep Services, PLLC

  • Dentist
  • Austin, TX
  • NPI 1891468112
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583971200000",
    "number": "1477558815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1719 BROADMOOR DR",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778025210",
            "telephone_number": "979-776-6884",
            "fax_number": "979-774-3008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1719 BROADMOOR DR",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778025210",
            "telephone_number": "979-776-6884",
            "fax_number": "979-774-3008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HATHAWAY",
        "first_name": "JENNIFER",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-14",
        "last_updated": "2020-03-12",
        "certification_date": "2020-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "17025",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Nicole Harrold
• Umbert Hart, M.D.
• Wallis Blake Harvey, DDS
• Robert B Hash, MD
• Morgan Hatfield, LPC-A
• Jennifer D Havel, PTA
• Kirstin Hayden, M.S. CCC-SLP
• Thomas Hayden, PTA
• Ashley Haynie, OT
• Stephen Hays, CRNA

• General Practice Dentistry in Bryan, TX
• Providers in Bryan, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.