MEDICARE: CHARLES HARTSFIELD JR DDS MS PA

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	516	AR
2	122300000X	Dentist	2155	AR

General Provider Information

NPI Number	:	1851597249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES HARTSFIELD JR DDS MS PA

Provider Business Mailing Address
First Line	:	613 LEXINGTON AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-4736
Country	:	US
Telephone Number	:	479-782-7230
Fax Number	:	479-782-7230

Provider Business Practice Location Address
First Line	:	613 LEXINGTON AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-4736
Country	:	US
Telephone Number	:	479-782-7230
Fax Number	:	479-782-7230

Authorized Official
Title or Position	:	PRESIDENT-OWNER DENTIST
Name	:	DR. CHARLES E HARTSFIELD JR.
Credential	:	DDS MS
Telephone Number	:	479-782-7230

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	09/16/2008

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