Healthcare Provider Details

I. General information

NPI: 1659827863
Provider Name (Legal Business Name): BRYCE LAWRENCE HARTMAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 CENTRE AVE STE 200
PITTSBURGH PA
15206-3710
US

IV. Provider business mailing address

3001 BRIGHTON ALY
BRIDGEVILLE PA
15017-4235
US

V. Phone/Fax

Practice location:
  • Phone: 412-661-7690
  • Fax: 412-661-7695
Mailing address:
  • Phone: 304-281-8905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS041190
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDS041190
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: