MEDICARE: DR. ERIC JON HARTZELL DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	6441	NC

General Provider Information

NPI Number	:	1063631869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC JON HARTZELL DMD

Provider Business Mailing Address
First Line	:	3931 TINSLEY DRIVE
Second Line	:	SUITE 101
City	:	HIGH POINT
State	:	NC
Zip	:	27265-1533
Country	:	US
Telephone Number	:	336-886-8776
Fax Number	:	336-886-8806

Provider Business Practice Location Address
First Line	:	3931 TINSLEY DRIVE
Second Line	:	SUITE 101
City	:	HIGH POINT
State	:	NC
Zip	:	27265-1533
Country	:	US
Telephone Number	:	336-886-8776
Fax Number	:	336-886-8806

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	07/08/2007

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