Provider Demographics
NPI:1003012519
Name:HART, JON EUGENE I (DMD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:EUGENE
Last Name:HART
Suffix:I
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 WOODS LN
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-9234
Mailing Address - Country:US
Mailing Address - Phone:717-632-8401
Mailing Address - Fax:
Practice Address - Street 1:138 BROADWAY
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-2500
Practice Address - Country:US
Practice Address - Phone:717-632-8571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA173101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice