Provider Demographics
NPI:1376523076
Name:HARTMANN, PAUL KIMBALL (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:KIMBALL
Last Name:HARTMANN
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 1:732 THIMBLE SHOALS BLVD
Mailing Address - Street 2:SUITE 202B
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4262
Mailing Address - Country:US
Mailing Address - Phone:757-595-8961
Mailing Address - Fax:757-595-4784
Practice Address - Street 1:1323 JAMESTOWN ROAD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23815-3367
Practice Address - Country:US
Practice Address - Phone:757-253-2393
Practice Address - Fax:757-259-0433
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010065001223G0001X
VA04380000931223S0112X
VA04280000931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T 21564Medicare UPIN
T21564Medicare UPIN
190000562Medicare PIN