Healthcare Provider Details

I. General information

NPI: 1033545892
Provider Name (Legal Business Name): HART FAMILY DENTISTRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 W 18TH AVE
MITCHELL SD
57301-5525
US

IV. Provider business mailing address

714 W 18TH AVE
MITCHELL SD
57301-5525
US

V. Phone/Fax

Practice location:
  • Phone: 605-996-0650
  • Fax: 855-345-7904
Mailing address:
  • Phone: 605-996-0650
  • Fax: 855-345-7904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD0081
License Number StateSD

VIII. Authorized Official

Name: KARISA A HART
Title or Position: OWNER
Credential:
Phone: 605-996-0650