Provider Demographics
NPI:1659827863
Name:HARTMAN, BRYCE LAWRENCE (DDS)
Entity Type:Individual
Prefix:
First Name:BRYCE
Middle Name:LAWRENCE
Last Name:HARTMAN
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 1:1909 WATERFRONT PL
Mailing Address - Street 2:APT 208
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15222-5707
Mailing Address - Country:US
Mailing Address - Phone:304-281-8905
Mailing Address - Fax:
Practice Address - Street 1:5820 CENTRE AVE STE 200
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3710
Practice Address - Country:US
Practice Address - Phone:412-661-7690
Practice Address - Fax:412-661-7695
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0411901223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1032791060004Medicaid
PA1032791060005Medicaid
PA1032791060002Medicaid
PA1032791060003Medicaid