Provider Demographics
NPI:1851813430
Name:HARTSELL, SHUTONG ZHAN (DMD)
Entity Type:Individual
Prefix:
First Name:SHUTONG
Middle Name:ZHAN
Last Name:HARTSELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 S CLARK ST STE 105
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-4050
Mailing Address - Country:US
Mailing Address - Phone:703-263-8009
Mailing Address - Fax:571-263-8009
Practice Address - Street 1:3400 S CLARK ST STE 105
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202-4050
Practice Address - Country:US
Practice Address - Phone:703-263-8009
Practice Address - Fax:571-263-8009
Is Sole Proprietor?:No
Enumeration Date:2017-07-14
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN10017501223G0001X
VA04014158371223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice