Provider Demographics
NPI:1659372886
Name:HARTMANN, CLIFFORD ROBERT
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:ROBERT
Last Name:HARTMANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10202 W HAYES AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2042
Mailing Address - Country:US
Mailing Address - Phone:414-543-4700
Mailing Address - Fax:414-543-4701
Practice Address - Street 1:10202 W HAYES AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2042
Practice Address - Country:US
Practice Address - Phone:414-543-4700
Practice Address - Fax:414-543-4701
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1464G1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry