Provider Demographics
NPI:1164571584
Name:HART, JAMES GLENN JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GLENN
Last Name:HART
Suffix:JR
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 1:3101 F W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32526
Mailing Address - Country:US
Mailing Address - Phone:850-944-5515
Mailing Address - Fax:850-944-0644
Practice Address - Street 1:3101 F W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32526
Practice Address - Country:US
Practice Address - Phone:850-944-5515
Practice Address - Fax:850-944-0644
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0013084122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist