Provider Demographics
NPI:1972677920
Name:HARTJES, JOEL MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:MARK
Last Name:HARTJES
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 1:1001 N GAMMON RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-3874
Mailing Address - Country:US
Mailing Address - Phone:608-836-5600
Mailing Address - Fax:608-836-4589
Practice Address - Street 1:1001 N GAMMON RD
Practice Address - Street 2:SUITE 2
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3874
Practice Address - Country:US
Practice Address - Phone:608-836-5600
Practice Address - Fax:608-836-4589
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33784500Medicaid