Healthcare Provider Details

I. General information

NPI: 1992712350
Provider Name (Legal Business Name): ANDREW CHARLES HARTWIG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2814 NORTHGATE DR SUITE 2
IOWA CITY IA
52245-9568
US

IV. Provider business mailing address

2814 NORTHGATE DR SUITE 2
IOWA CITY IA
52245-9568
US

V. Phone/Fax

Practice location:
  • Phone: 319-338-5484
  • Fax: 319-338-9413
Mailing address:
  • Phone: 319-338-5484
  • Fax: 319-338-9413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number07663
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: