Provider Demographics
NPI:1992815799
Name:HART, BRIAN T (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:T
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 1:4407 106TH ST SW #B
Mailing Address - Street 2:
Mailing Address - City:MUKILTCO
Mailing Address - State:WA
Mailing Address - Zip Code:98275
Mailing Address - Country:US
Mailing Address - Phone:425-353-1009
Mailing Address - Fax:425-353-8517
Practice Address - Street 1:4407 106TH ST SW #B
Practice Address - Street 2:
Practice Address - City:MUKILTCO
Practice Address - State:WA
Practice Address - Zip Code:98275
Practice Address - Country:US
Practice Address - Phone:425-353-1009
Practice Address - Fax:425-353-8517
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADC7300122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist