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General NPI Number Information
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NPI Number | 1528203973
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Entity Type | Organization
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Legal Business Name | HANOVER FAMILY DENTISTRY
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Dates
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Enumeration Date | 12/12/2008
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Last Update Date | 12/12/2008
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Provider Practice Location Address
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Address Line | 301 E STATE ST
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City | HANOVER
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State | MI
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Zip | 49241-9815
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Country | US
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Telephone | 517-563-2314
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Fax | 517-563-8376
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Provider Business Mailing Address
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Address Line | 301 E STATE ST P.O. BOX 400
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City | HANOVER
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State | MI
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Zip | 49241-9815
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Country | US
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Telephone | 517-563-2314
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Fax | 517-563-8376
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMIE BARTMAN
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Credential | DMD
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Telephone | 517-563-2314
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State | MI
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