Provider Demographics
NPI:1417007568
Name:HARTZELL, NANCY M (DDS)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:M
Last Name:HARTZELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4022 W RAUCH RD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49270-9623
Mailing Address - Country:US
Mailing Address - Phone:419-410-0926
Mailing Address - Fax:
Practice Address - Street 1:1101 N UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-1085
Practice Address - Country:US
Practice Address - Phone:734-647-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2021-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH19496 OH1223G0001X
MI2901016231122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice