Healthcare Provider Details

I. General information

NPI: 1427272699
Provider Name (Legal Business Name): JASON WILLIAM HARTMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 E MOUNT HOPE AVE
LANSING MI
48910-1916
US

IV. Provider business mailing address

2805 E MOUNT HOPE AVE
LANSING MI
48910-1916
US

V. Phone/Fax

Practice location:
  • Phone: 517-484-5811
  • Fax: 517-484-5873
Mailing address:
  • Phone: 517-484-5811
  • Fax: 517-484-5873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number17874
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: