Provider Demographics
NPI:1194590919
Name:HARTZOG DENTAL, P.C.
Entity type:Organization
Organization Name:HARTZOG DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:HARTZOG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:334-332-4764
Mailing Address - Street 1:654 VALLEY CUB DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:AL
Mailing Address - Zip Code:36250-4200
Mailing Address - Country:US
Mailing Address - Phone:256-847-1111
Mailing Address - Fax:
Practice Address - Street 1:654 VALLEY CUB DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:AL
Practice Address - Zip Code:36250-4200
Practice Address - Country:US
Practice Address - Phone:256-847-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental