MEDICARE: DR. DENNIS B HARTLIEB DDS

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	1223G0001X	General Practice Dentistry	19A21551	IL

General Provider Information

NPI Number	:	1881756682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS B HARTLIEB DDS

Provider Business Mailing Address
First Line	:	2601 COMPASS RD
Second Line	:	SUITE 100
City	:	GLENVIEW
State	:	IL
Zip	:	60026-8077
Country	:	US
Telephone Number	:	847-729-6080
Fax Number	:	847-729-7809

Provider Business Practice Location Address
First Line	:	2601 COMPASS RD
Second Line	:	SUITE 100
City	:	GLENVIEW
State	:	IL
Zip	:	60026-8077
Country	:	US
Telephone Number	:	847-729-6080
Fax Number	:	847-729-7809

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	03/24/2010

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