Provider Demographics
NPI:1063631869
Name:HARTZELL, ERIC JON (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JON
Last Name:HARTZELL
Suffix:
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 1:3931 TINSLEY DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-1533
Mailing Address - Country:US
Mailing Address - Phone:336-886-8776
Mailing Address - Fax:336-886-8806
Practice Address - Street 1:3931 TINSLEY DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-1533
Practice Address - Country:US
Practice Address - Phone:336-886-8776
Practice Address - Fax:336-886-8806
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6441122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist