Provider Demographics
NPI:1982778833
Name:HARTJES DENTAL ASSOCIATION, LLC
Entity Type:Organization
Organization Name:HARTJES DENTAL ASSOCIATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARTJES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:608-836-5600
Mailing Address - Street 1:1001 N GAMMON RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-3874
Mailing Address - Country:US
Mailing Address - Phone:608-836-5600
Mailing Address - Fax:608-836-4589
Practice Address - Street 1:1001 N GAMMON RD
Practice Address - Street 2:SUITE 2
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3874
Practice Address - Country:US
Practice Address - Phone:608-836-5600
Practice Address - Fax:608-836-4589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4461 & 28351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33431600Medicaid
WI33784500Medicaid