Provider Demographics
NPI:1942261060
Name:HARTWELL, BRIAN D (DDS)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:HARTWELL
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 1:2911 WEST RD
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2469
Mailing Address - Country:US
Mailing Address - Phone:374-675-5700
Mailing Address - Fax:734-676-1668
Practice Address - Street 1:2911 WEST RD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-2469
Practice Address - Country:US
Practice Address - Phone:374-675-5700
Practice Address - Fax:734-676-1668
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI09617122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist