Provider Demographics
NPI:1730212598
Name:HART FAMILY DENTISTRY SC
Entity type:Organization
Organization Name:HART FAMILY DENTISTRY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:608-742-3272
Mailing Address - Street 1:225 GUNDERSON DR
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-3430
Mailing Address - Country:US
Mailing Address - Phone:608-742-3272
Mailing Address - Fax:608-742-0523
Practice Address - Street 1:225 GUNDERSON DR
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-3430
Practice Address - Country:US
Practice Address - Phone:608-742-3272
Practice Address - Fax:608-742-0523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty