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General NPI Number Information
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NPI Number | 1780910604
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Entity Type | Organization
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Legal Business Name | HART FAMILY DENTAL
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Dates
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Enumeration Date | 10/28/2009
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Last Update Date | 10/28/2009
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Provider Practice Location Address
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Address Line | 56728 29 PALMS HWY
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City | YUCCA VALLEY
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State | CA
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Zip | 92284-2941
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Country | US
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Telephone | 760-365-6595
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Fax |
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Provider Business Mailing Address
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Address Line | 56728 29 PALMS HWY
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City | YUCCA VALLEY
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State | CA
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Zip | 92284-2941
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Country | US
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Telephone | 760-365-6595
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CICI M MANTHEY
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Credential |
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Telephone | 760-329-6713
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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 | 30554
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License Number State | CA
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