Healthcare Provider Details

I. General information

NPI: 1295992709
Provider Name (Legal Business Name): RONALD C HARTZER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 W GREENWOOD AVE
WAUKEGAN IL
60087-5000
US

IV. Provider business mailing address

609 W GREENWOOD AVE
WAUKEGAN IL
60087-5000
US

V. Phone/Fax

Practice location:
  • Phone: 847-244-9000
  • Fax: 847-244-0009
Mailing address:
  • Phone: 847-244-9000
  • Fax: 847-244-0009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number019013133
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: