Provider Demographics
NPI:1407975329
Name:HART, THOMAS J JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:HART
Suffix:JR
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 1:3735 CANTON RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-2663
Mailing Address - Country:US
Mailing Address - Phone:770-926-8371
Mailing Address - Fax:770-926-7131
Practice Address - Street 1:3735 CANTON RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-2663
Practice Address - Country:US
Practice Address - Phone:770-926-8371
Practice Address - Fax:770-926-7131
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8668122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist