Provider Demographics
NPI:1992847008
Name:HARTSOCK, TOM E (DMD,MS)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:E
Last Name:HARTSOCK
Suffix:
Gender:M
Credentials:DMD,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 COLLEGE ST
Mailing Address - Street 2:SUITE #3
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-4786
Mailing Address - Country:US
Mailing Address - Phone:606-432-3603
Mailing Address - Fax:
Practice Address - Street 1:161 COLLEGE ST
Practice Address - Street 2:SUITE #3
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-4786
Practice Address - Country:US
Practice Address - Phone:606-432-3603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY65161223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY$$$$$$$$$OtherSOCIAL SECURITY
KY60065166Medicaid