Provider Demographics
NPI:1902950694
Name:HART, HIRAM REID (DDS MAGD)
Entity Type:Individual
Prefix:MR
First Name:HIRAM
Middle Name:REID
Last Name:HART
Suffix:
Gender:M
Credentials:DDS MAGD
Other - Prefix:
Other - First Name:H
Other - Middle Name:REID
Other - Last Name:HART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:44 SHORELINE DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562
Mailing Address - Country:US
Mailing Address - Phone:252-638-3838
Mailing Address - Fax:252-635-1923
Practice Address - Street 1:44 SHORELINE DRIVE
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562
Practice Address - Country:US
Practice Address - Phone:252-638-3838
Practice Address - Fax:252-635-1923
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC47751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC93659OtherBCBS
504698OtherUNITED CONCORDIA