Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223X0400X | Orthodontists | 1005 | AK |
Y | 1223X0400X | Orthodontists | 1223X0400X | AK |
NPI | 1033227954 |
---|---|
Provider Name | Dr. Brian D Hartman |
First Address | Anchorage, AK 99502-1668 |
Second Address | Anchorage, AK 99502-1668 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 23/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DD0361 | (05) | AK |