Provider Demographics
NPI:1760684435
Name:HANTMAN, MITCHELL MARC (DMD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:MARC
Last Name:HANTMAN
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 1:700 W HILLSBORO BLVD
Mailing Address - Street 2:BUILDING 1 - SUITE 109
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-1612
Mailing Address - Country:US
Mailing Address - Phone:954-698-9499
Mailing Address - Fax:
Practice Address - Street 1:700 W HILLSBORO BLVD
Practice Address - Street 2:BUILDING 1 - SUITE 109
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-1612
Practice Address - Country:US
Practice Address - Phone:954-698-9499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL92241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice