Provider Demographics
NPI:1750906210
Name:HARTFORD, AUSTIN TEHUIARII (DMD)
Entity type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:TEHUIARII
Last Name:HARTFORD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 LYNCH CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-8301
Mailing Address - Country:US
Mailing Address - Phone:707-766-6666
Mailing Address - Fax:
Practice Address - Street 1:101 LYNCH CREEK WAY
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-8301
Practice Address - Country:US
Practice Address - Phone:707-766-6666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104920122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist