Provider Demographics
NPI:1477683290
Name:HARTZEL, JAMES JACOB (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JACOB
Last Name:HARTZEL
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 1:25880 TOURNAMENT RD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-2349
Mailing Address - Country:US
Mailing Address - Phone:661-255-1211
Mailing Address - Fax:661-255-1155
Practice Address - Street 1:25880 TOURNAMENT RD
Practice Address - Street 2:SUITE 214
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-2349
Practice Address - Country:US
Practice Address - Phone:661-255-1211
Practice Address - Fax:661-255-1155
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA310811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice