Provider Demographics
NPI:1114020492
Name:HARTMAN, EILEEN L (RDH)
Entity Type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:L
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:38TH STREET/BLDG 38717
Mailing Address - Street 2:USA DENTAC
Mailing Address - City:FT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5660
Mailing Address - Country:US
Mailing Address - Phone:706-787-6927
Mailing Address - Fax:706-787-2082
Practice Address - Street 1:38TH STREET/BLDG 38717
Practice Address - Street 2:USA DENTAC
Practice Address - City:FT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5660
Practice Address - Country:US
Practice Address - Phone:706-787-6927
Practice Address - Fax:706-787-2082
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5604-016124Q00000X
SC2555124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered124Q00000XDental ProvidersDental Hygienist