Individual
BRIAN HART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
225 GUNDERSON DR, PORTAGE, WI 53901-3430
(608) 697-2484
Mailing address
225 GUNDERSON DR, PORTAGE, WI 53901-3430
(608) 697-2484
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/12/2017
Last updated
04/12/2017
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