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General NPI Number Information
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NPI Number | 1619023082
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Entity Type | Organization
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Legal Business Name | TIMOTHY O. HART DDS MS, LTD
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1720 E LAKE BLUFF BLVD
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City | SHOREWOOD
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State | WI
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Zip | 53211-1517
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Country | US
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Telephone | 414-962-1800
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Fax | 414-962-2302
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Provider Business Mailing Address
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Address Line | 1720 E LAKE BLUFF BLVD
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City | SHOREWOOD
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State | WI
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Zip | 53211-1517
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Country | US
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Telephone | 414-962-1800
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Fax | 414-962-2302
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TIMOTHY OTTO HART
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Credential | D.D.S.
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Telephone | 414-962-1800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 1896G
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License Number State | WI
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