Provider Demographics
NPI:1801000641
Name:HART, GREGORY A (DDS)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:A
Last Name:HART
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 1:3274 NE CATAWBA RD
Mailing Address - Street 2:
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-9803
Mailing Address - Country:US
Mailing Address - Phone:419-797-2010
Mailing Address - Fax:419-797-2826
Practice Address - Street 1:3274 NE CATAWBA RD
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-9803
Practice Address - Country:US
Practice Address - Phone:419-797-2010
Practice Address - Fax:419-797-2826
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300160701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0395086Medicaid