Provider Demographics
NPI:1497137517
Name:HARTMAN, ANDREW (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:HARTMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3481 NAMEOKI RD
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-3709
Mailing Address - Country:US
Mailing Address - Phone:618-452-2006
Mailing Address - Fax:618-452-3077
Practice Address - Street 1:3481 NAMEOKI RD
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-3709
Practice Address - Country:US
Practice Address - Phone:618-452-2006
Practice Address - Fax:618-452-3077
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.030181122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist