Healthcare Provider Details

I. General information

NPI: 1376753830
Provider Name (Legal Business Name): JAYSON S HARTMAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 SE 6TH AVE
DELRAY BEACH FL
33483-5185
US

IV. Provider business mailing address

17622 CIRCLE POND CT
BOCA RATON FL
33496
US

V. Phone/Fax

Practice location:
  • Phone: 561-272-2424
  • Fax:
Mailing address:
  • Phone: 561-866-2997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN 15981
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: