Provider Demographics
NPI:1033227954
Name:HARTMAN, BRIAN D (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:D
Last Name:HARTMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:TOM
Other - Middle Name:J
Other - Last Name:HARTMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:2700 W DIMOND BLVD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-1668
Mailing Address - Country:US
Mailing Address - Phone:907-248-6000
Mailing Address - Fax:907-248-6000
Practice Address - Street 1:2700 W DIMOND BLVD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-1668
Practice Address - Country:US
Practice Address - Phone:907-248-6000
Practice Address - Fax:907-245-0423
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK10051223X0400X
AK1223X0400X1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDD0361Medicaid