Provider Demographics
NPI:1710531702
Name:HARTFORD FAMILY DENTAL CARE, LLC
Entity Type:Organization
Organization Name:HARTFORD FAMILY DENTAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARMOLI
Authorized Official - Suffix:
Authorized Official - Credentials:RDH, BS
Authorized Official - Phone:262-673-2960
Mailing Address - Street 1:73 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53027-8739
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:73 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:WI
Practice Address - Zip Code:53027-8739
Practice Address - Country:US
Practice Address - Phone:262-673-2960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-28
Last Update Date:2019-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental