MEDICARE: DAVID EDWARD HARTMAN D.D.S.

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	1223G0001X	General Practice Dentistry	15590	OH

General Provider Information

NPI Number	:	1275656720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID EDWARD HARTMAN D.D.S.

Provider Business Mailing Address
First Line	:	2410 SYLVESTER DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45409-1920
Country	:	US
Telephone Number	:	937-294-1571
Fax Number	:

Provider Business Practice Location Address
First Line	:	7111 N MAIN ST
Second Line	:	SUITE 40
City	:	DAYTON
State	:	OH
Zip	:	45415-2565
Country	:	US
Telephone Number	:	937-274-1127
Fax Number	:	937-274-6834

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	02/23/2015

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