Provider Demographics
NPI:1962424283
Name:HARTTER, MARK EARL (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:EARL
Last Name:HARTTER
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 1:30706 E STATE ROUTE VV
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:MO
Mailing Address - Zip Code:64080-8305
Mailing Address - Country:US
Mailing Address - Phone:816-540-4070
Mailing Address - Fax:
Practice Address - Street 1:3568 SW MARKET ST
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64082-2327
Practice Address - Country:US
Practice Address - Phone:816-537-6161
Practice Address - Fax:816-537-6165
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO122901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice