Provider Demographics
NPI:1205938529
Name:HART, BEVERLY JEAN
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:JEAN
Last Name:HART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 NE HAZEL DELL AVE
Mailing Address - Street 2:APT K12
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-8069
Mailing Address - Country:US
Mailing Address - Phone:360-576-1016
Mailing Address - Fax:
Practice Address - Street 1:8500 NE HAZEL DELL AVE
Practice Address - Street 2:APT K12
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8069
Practice Address - Country:US
Practice Address - Phone:360-576-1016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant