Provider Demographics
NPI:1619228806
Name:HACKMAN, ROBERT BARTHOLOMEW (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BARTHOLOMEW
Last Name:HACKMAN
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 1:2590 PARK CENTER BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-2799
Mailing Address - Country:US
Mailing Address - Phone:814-234-6826
Mailing Address - Fax:814-234-2497
Practice Address - Street 1:2590 PARK CENTER BLVD STE 100
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-2799
Practice Address - Country:US
Practice Address - Phone:814-234-6826
Practice Address - Fax:814-234-2497
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039245122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist