Provider Demographics
NPI:1841295599
Name:HARTL, GEORGE G (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:G
Last Name:HARTL
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-3007
Mailing Address - Country:US
Mailing Address - Phone:262-334-2361
Mailing Address - Fax:262-334-1664
Practice Address - Street 1:1305 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-3007
Practice Address - Country:US
Practice Address - Phone:262-334-2361
Practice Address - Fax:262-334-1664
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3483-0151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics