Provider Demographics
NPI:1487855326
Name:HARTMAN, ROSANNE MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROSANNE
Middle Name:MARIE
Last Name:HARTMAN
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 1:910 WESTCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1830
Mailing Address - Country:US
Mailing Address - Phone:313-823-0373
Mailing Address - Fax:
Practice Address - Street 1:35409 23 MILE RD
Practice Address - Street 2:
Practice Address - City:NEW BALTIMORE
Practice Address - State:MI
Practice Address - Zip Code:48047-3601
Practice Address - Country:US
Practice Address - Phone:586-725-9330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI136081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3280641Medicaid