Provider Demographics
NPI:1619075371
Name:DAYLE V. HARTGERINK, DDS, MS, PC
Entity Type:Organization
Organization Name:DAYLE V. HARTGERINK, DDS, MS, PC
Other - Org Name:RANGEWOOD ORTHODONTICS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAYLE
Authorized Official - Middle Name:V
Authorized Official - Last Name:HARTGERINK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:719-596-3113
Mailing Address - Street 1:7560 RANGEWOOD
Mailing Address - Street 2:#200
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920
Mailing Address - Country:US
Mailing Address - Phone:719-596-3113
Mailing Address - Fax:719-596-3254
Practice Address - Street 1:7560 RANGEWOOD
Practice Address - Street 2:#200
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920
Practice Address - Country:US
Practice Address - Phone:719-596-3113
Practice Address - Fax:719-596-3254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1056181223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty