Provider Demographics
NPI:1265859565
Name:HARTRICK FAMILY DENTISTRY P C
Entity type:Organization
Organization Name:HARTRICK FAMILY DENTISTRY P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-549-0950
Mailing Address - Street 1:32609 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-0952
Mailing Address - Country:US
Mailing Address - Phone:248-549-0950
Mailing Address - Fax:248-549-1180
Practice Address - Street 1:32609 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-0952
Practice Address - Country:US
Practice Address - Phone:248-549-0950
Practice Address - Fax:248-549-1180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-25
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI12800332BC3200X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty