Provider Demographics
NPI:1427272699
Name:HARTMAN, JASON WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:WILLIAM
Last Name:HARTMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 E MOUNT HOPE AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-1916
Mailing Address - Country:US
Mailing Address - Phone:517-484-5811
Mailing Address - Fax:517-484-5873
Practice Address - Street 1:2805 E MOUNT HOPE AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-1916
Practice Address - Country:US
Practice Address - Phone:517-484-5811
Practice Address - Fax:517-484-5873
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI178741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice