Provider Demographics
NPI:1336383454
Name:HARTMAN, DEBRA ANNE (RDHAP)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:ANNE
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20229 E LORENCITA DR
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-3834
Mailing Address - Country:US
Mailing Address - Phone:909-208-7886
Mailing Address - Fax:626-967-4002
Practice Address - Street 1:20229 E LORENCITA DR
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-3834
Practice Address - Country:US
Practice Address - Phone:909-208-7886
Practice Address - Fax:626-967-4002
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP102124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist