Provider Demographics
NPI:1598812802
Name:HART, HARRY ALLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:ALLEN
Last Name:HART
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 1:2363 TRAFALGAR AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-4627
Mailing Address - Country:US
Mailing Address - Phone:951-377-7455
Mailing Address - Fax:
Practice Address - Street 1:11999 PALM DR
Practice Address - Street 2:
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92240-3609
Practice Address - Country:US
Practice Address - Phone:760-329-6713
Practice Address - Fax:760-329-1088
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice