Provider Demographics
NPI:1851597249
Name:CHARLES HARTSFIELD JR DDS MS PA
Entity Type:Organization
Organization Name:CHARLES HARTSFIELD JR DDS MS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:HARTSFIELD
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:479-782-7230
Mailing Address - Street 1:613 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-4736
Mailing Address - Country:US
Mailing Address - Phone:479-782-7230
Mailing Address - Fax:479-782-7230
Practice Address - Street 1:613 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4736
Practice Address - Country:US
Practice Address - Phone:479-782-7230
Practice Address - Fax:479-782-7230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2155122300000X
AR516122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty