Provider Demographics
NPI:1164423497
Name:HARTSFIELD, DARRELL TODD (DDS)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:TODD
Last Name:HARTSFIELD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15350 W SKYVIEW WAY
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-4774
Mailing Address - Country:US
Mailing Address - Phone:602-307-1576
Mailing Address - Fax:
Practice Address - Street 1:15350 W SKYVIEW WAY
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-4774
Practice Address - Country:US
Practice Address - Phone:602-307-1576
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ60181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ857469Medicaid