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General NPI Number Information
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NPI Number | 1457642746
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Entity Type | Organization
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Legal Business Name | C. R. HARTMANN, D.D.S., S.C.
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Dates
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Enumeration Date | 04/21/2011
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Last Update Date | 04/21/2011
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Provider Practice Location Address
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Address Line | 10202 W HAYES AVE
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City | WEST ALLIS
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State | WI
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Zip | 53227-2042
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Country | US
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Telephone | 414-543-4700
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Fax | 414-543-4701
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Provider Business Mailing Address
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Address Line | 10202 W HAYES AVE
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City | WEST ALLIS
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State | WI
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Zip | 53227-2042
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Country | US
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Telephone | 414-543-4700
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Fax | 414-543-4701
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Authorized Official
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Title or Position | PRESIDENT
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Name | CLIFF HARTMANN
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Credential | DDS
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Telephone | 414-543-4700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 1464
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License Number State | WI
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