Provider Demographics
NPI:1326365248
Name:DEBRA ANNE HARTMAN PROFESSIONAL DENTAL HYGIENE CORPORATION
Entity Type:Organization
Organization Name:DEBRA ANNE HARTMAN PROFESSIONAL DENTAL HYGIENE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RDHAP
Authorized Official - Phone:909-208-7886
Mailing Address - Street 1:20229 E LORENCITA DR
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-3834
Mailing Address - Country:US
Mailing Address - Phone:909-208-7886
Mailing Address - Fax:626-967-4002
Practice Address - Street 1:20229 E LORENCITA DR
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-3834
Practice Address - Country:US
Practice Address - Phone:909-208-7886
Practice Address - Fax:626-967-4002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-02
Last Update Date:2010-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP102124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty