Provider Demographics
NPI:1083982920
Name:HARTLINE, CARRIE BETH (HYGIENIST)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:BETH
Last Name:HARTLINE
Suffix:
Gender:F
Credentials:HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3914 COUNTY ROAD 3110
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:TX
Mailing Address - Zip Code:75422-3244
Mailing Address - Country:US
Mailing Address - Phone:903-456-9124
Mailing Address - Fax:903-454-4621
Practice Address - Street 1:3600 CADDO ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-4511
Practice Address - Country:US
Practice Address - Phone:903-454-6965
Practice Address - Fax:903-454-7981
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3704124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist