Provider Demographics
NPI:1083605521
Name:THOMAS K HARTZ DMD PC
Entity Type:Organization
Organization Name:THOMAS K HARTZ DMD PC
Other - Org Name:RESTORATIVE DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:K
Authorized Official - Last Name:HARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:931-648-0604
Mailing Address - Street 1:237A DUNBAR CAVE RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5734
Mailing Address - Country:US
Mailing Address - Phone:931-648-0604
Mailing Address - Fax:931-648-0605
Practice Address - Street 1:237A DUNBAR CAVE RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5734
Practice Address - Country:US
Practice Address - Phone:931-648-0604
Practice Address - Fax:931-648-0605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS3159122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0016171Medicaid
TN0016171Medicaid