Provider Demographics
NPI:1568599066
Name:HARTSOOK, TIMOTHY MERWYN (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:MERWYN
Last Name:HARTSOOK
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 1:223 1ST ST W
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:IA
Mailing Address - Zip Code:50644-2604
Mailing Address - Country:US
Mailing Address - Phone:319-334-3512
Mailing Address - Fax:319-334-3512
Practice Address - Street 1:223 1ST ST W
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:IA
Practice Address - Zip Code:50644-2604
Practice Address - Country:US
Practice Address - Phone:319-334-3512
Practice Address - Fax:319-334-3512
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA067701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1059550Medicare ID - Type Unspecified