Healthcare Provider Details

I. General information

NPI: 1154521599
Provider Name (Legal Business Name): ROSALIND IGNACIO HARTLAND DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 06/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 SOUTH MAIN STREET
FOREST CITY PA
18421-0144
US

IV. Provider business mailing address

117 SOUTH MAIN STREET PO BOX 144
FOREST CITY PA
18421-0144
US

V. Phone/Fax

Practice location:
  • Phone: 570-785-3000
  • Fax: 570-785-3175
Mailing address:
  • Phone: 570-785-3000
  • Fax: 570-785-3175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS035200
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: