MEDICARE: HART DENTAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	7729107-9921	UT
2	1223G0001X	General Practice Dentistry	6248077-9922	UT

General Provider Information

NPI Number	:	1730455882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HART DENTAL

Provider Business Mailing Address
First Line	:	3566 PONY EXPRESS PKWY
Second Line	:	ST #1
City	:	EAGLE MOUNTAIN
State	:	UT
Zip	:	84005-6018
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3566 PONY EXPRESS PKWY
Second Line	:	ST #1
City	:	EAGLE MOUNTAIN
State	:	UT
Zip	:	84005-6018
Country	:	US
Telephone Number	:	801-789-7500
Fax Number	:	801-789-7788

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. RYAN RICHARD HART
Credential	:	D.D.S.
Telephone Number	:	801-789-7500

Provider Enumeration Date	:	03/22/2012
Last Update Date	:	03/22/2012

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Directions to “HART DENTAL ” Practice Location

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