Provider Demographics
NPI:1770742389
Name:RONALD C. HARTZER D.D.S.,M.S., PERIODONTICS, LTD.
Entity type:Organization
Organization Name:RONALD C. HARTZER D.D.S.,M.S., PERIODONTICS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:HARTZER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:847-244-9000
Mailing Address - Street 1:609 W GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60087-5000
Mailing Address - Country:US
Mailing Address - Phone:847-244-9000
Mailing Address - Fax:847-244-0009
Practice Address - Street 1:609 W GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60087-5000
Practice Address - Country:US
Practice Address - Phone:847-244-9000
Practice Address - Fax:847-244-0009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019013133261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental