Provider Demographics
NPI:1710554878
Name:HARTZOG, JOHN MARSHALL (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MARSHALL
Last Name:HARTZOG
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 1:235 OAKLAND DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36203-4605
Mailing Address - Country:US
Mailing Address - Phone:334-332-4764
Mailing Address - Fax:
Practice Address - Street 1:654 VALLEY CUB DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:AL
Practice Address - Zip Code:36250-4200
Practice Address - Country:US
Practice Address - Phone:256-847-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD-0006900-C11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice