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General NPI Number Information
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NPI Number | 1669283057
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Entity Type | Organization
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Legal Business Name | HART FAMILY DENTISTRY PC
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Dates
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Enumeration Date | 01/15/2025
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 403 DEER VIEW AVE
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City | TIFFIN
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State | IA
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Zip | 52340-4725
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Country | US
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Telephone | 319-545-7630
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Fax |
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Provider Business Mailing Address
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Address Line | 25 PARK PL
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City | TIFFIN
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State | IA
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Zip | 52340-7100
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Country | US
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Telephone | 319-936-7898
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEVIN HART
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Credential | DDS
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Telephone | 319-545-7630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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