Provider Demographics
NPI:1619023082
Name:TIMOTHY O. HART DDS MS, LTD
Entity Type:Organization
Organization Name:TIMOTHY O. HART DDS MS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:OTTO
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:414-962-1800
Mailing Address - Street 1:1720 E LAKE BLUFF BLVD
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-1517
Mailing Address - Country:US
Mailing Address - Phone:414-962-1800
Mailing Address - Fax:414-962-2302
Practice Address - Street 1:1720 E LAKE BLUFF BLVD
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-1517
Practice Address - Country:US
Practice Address - Phone:414-962-1800
Practice Address - Fax:414-962-2302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1896G1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty