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General NPI Number Information
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NPI Number | 1922840438
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Entity Type | Organization
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Legal Business Name | AREA DENTAL HARTFORD, LLC
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Dates
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Enumeration Date | 06/07/2024
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Last Update Date | 06/07/2024
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Provider Practice Location Address
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Address Line | 73 LIBERTY AVE
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City | HARTFORD
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State | WI
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Zip | 53027-8739
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Country | US
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Telephone | 262-673-2960
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Fax |
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Provider Business Mailing Address
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Address Line | 1149 BOUGHTON ST BLDG B
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City | WATERTOWN
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State | WI
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Zip | 53094-3104
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Country | US
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Telephone | 920-285-9191
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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. JARROD THOMAS
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Credential | DDS
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Telephone | 920-285-9191
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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 |
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