Richard Shad Hattaway, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

30158 Issued in TX

Practice address

6452 Broadway Boulevard
Garland, TX 75043

Phone

(972) 226-6945

Fax

(972) 226-6608

NPI assigned

Apr 29, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Dr. Shad Hattaway Other name

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Dennis M Abbott DDS PA

  • General Practice Dentistry
  • Garland, TX
  • NPI 1477918704
  NPD (past)

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

{
    "created_epoch": "1367193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450224000000",
    "number": "1992149306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6452 BROADWAY BOULEVARD",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "75043",
            "telephone_number": "972-226-6945",
            "fax_number": "972-226-6608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6452 BROADWAY BOULEVARD",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "75043",
            "telephone_number": "972-226-6945",
            "fax_number": "972-226-6608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HATTAWAY",
        "first_name": "RICHARD",
        "middle_name": "SHAD",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-04-29",
        "last_updated": "2015-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30-023996",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "30158",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHAD",
            "last_name": "HATTAWAY",
            "prefix": "DR.",
            "credential": "D.D.S.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Sandra Hart
• Rachel A. Hartman, M.D.
• John Robert Hartono, MD
• Jared Michael Harvey, DDS, MS
• Saira M Hassan, MD
• Haven Innerhealing Ministries
• Ziad Rafic Haydar
• Kaylan A Hayes
• Larry D Hayes, DPM
• Morgan Haygood, MS, RD, LD

• Dentist in Garland, TX
• Providers in Garland, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.