Provider Demographics
NPI:1669283057
Name:HART FAMILY DENTISTRY PC
Entity type:Organization
Organization Name:HART FAMILY DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-545-7630
Mailing Address - Street 1:25 PARK PL
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:IA
Mailing Address - Zip Code:52340-7100
Mailing Address - Country:US
Mailing Address - Phone:319-936-7898
Mailing Address - Fax:
Practice Address - Street 1:403 DEER VIEW AVE
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:IA
Practice Address - Zip Code:52340-4725
Practice Address - Country:US
Practice Address - Phone:319-545-7630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental