Provider Demographics
NPI:1356591903
Name:HARTMAN, JASON MICHAEL (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:MICHAEL
Last Name:HARTMAN
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 1:701 W UNION BLVD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-3700
Mailing Address - Country:US
Mailing Address - Phone:610-334-3278
Mailing Address - Fax:
Practice Address - Street 1:701 W UNION BLVD
Practice Address - Street 2:SUITE 11
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-3700
Practice Address - Country:US
Practice Address - Phone:610-334-3278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0525401223X0400X
NJ22DI023743001223X0400X
PADS0380551223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics