MEDICARE: DR. KRISTOPHER REX HARTH 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	DN18273	FL

General Provider Information

NPI Number	:	1679721286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTOPHER REX HARTH DMD

Provider Business Mailing Address
First Line	:	105 SOLANA RD STE A
Second Line	:
City	:	PONTE VEDRA
State	:	FL
Zip	:	32082-5229
Country	:	US
Telephone Number	:	904-285-7711
Fax Number	:	904-285-7895

Provider Business Practice Location Address
First Line	:	105 SOLANA RD STE A
Second Line	:
City	:	PONTE VEDRA
State	:	FL
Zip	:	32082-5229
Country	:	US
Telephone Number	:	904-285-7711
Fax Number	:	904-285-7895

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

Provider Enumeration Date	:	09/08/2008
Last Update Date	:	09/08/2008

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