Provider Demographics
NPI:1881820637
Name:HARTZOG, EARL BARRETT (DMD)
Entity Type:Individual
Prefix:DR
First Name:EARL
Middle Name:BARRETT
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 1:174 BEECH AVE
Mailing Address - Street 2:
Mailing Address - City:DENMARK
Mailing Address - State:SC
Mailing Address - Zip Code:29042
Mailing Address - Country:US
Mailing Address - Phone:803-793-3653
Mailing Address - Fax:803-793-0927
Practice Address - Street 1:174 BEECH AVE
Practice Address - Street 2:
Practice Address - City:DENMARK
Practice Address - State:SC
Practice Address - Zip Code:29042
Practice Address - Country:US
Practice Address - Phone:803-793-3653
Practice Address - Fax:803-793-0927
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-08
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4591122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist