Provider Demographics
NPI:1457642746
Name:C. R. HARTMANN, D.D.S., S.C.
Entity Type:Organization
Organization Name:C. R. HARTMANN, D.D.S., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLIFF
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:414-543-4700
Mailing Address - Street 1:10202 W HAYES AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2042
Mailing Address - Country:US
Mailing Address - Phone:414-543-4700
Mailing Address - Fax:414-543-4701
Practice Address - Street 1:10202 W HAYES AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2042
Practice Address - Country:US
Practice Address - Phone:414-543-4700
Practice Address - Fax:414-543-4701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14641223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty