Provider Demographics
NPI:1417160623
Name:HARTWICK, DAVID WILTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WILTON
Last Name:HARTWICK
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 1:2650 LARKSPUR LANE
Mailing Address - Street 2:SUITE A
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1905
Mailing Address - Country:US
Mailing Address - Phone:530-222-0885
Mailing Address - Fax:530-222-6616
Practice Address - Street 1:2650 LARKSPUR LANE
Practice Address - Street 2:SUITE A
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1905
Practice Address - Country:US
Practice Address - Phone:530-222-0885
Practice Address - Fax:530-222-6616
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA303031223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA68-0201494OtherTIN