Provider Demographics
NPI:1164828059
Name:HART DDS PC
Entity Type:Organization
Organization Name:HART DDS PC
Other - Org Name:DELICATE SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHACON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-902-9100
Mailing Address - Street 1:4531 PHILADELPHIA ST
Mailing Address - Street 2:UNIT 107
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2262
Mailing Address - Country:US
Mailing Address - Phone:909-902-9100
Mailing Address - Fax:909-902-9112
Practice Address - Street 1:4531 PHILADELPHIA ST
Practice Address - Street 2:UNIT 107
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2262
Practice Address - Country:US
Practice Address - Phone:909-902-9100
Practice Address - Fax:909-902-9112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-05
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty