Provider Demographics
NPI:1528203973
Name:HANOVER FAMILY DENTISTRY
Entity Type:Organization
Organization Name:HANOVER FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:517-563-2314
Mailing Address - Street 1:301 E STATE ST
Mailing Address - Street 2:P.O. BOX 400
Mailing Address - City:HANOVER
Mailing Address - State:MI
Mailing Address - Zip Code:49241-9815
Mailing Address - Country:US
Mailing Address - Phone:517-563-2314
Mailing Address - Fax:517-563-8376
Practice Address - Street 1:301 E STATE ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MI
Practice Address - Zip Code:49241-9815
Practice Address - Country:US
Practice Address - Phone:517-563-2314
Practice Address - Fax:517-563-8376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty