Organization
HAVEN ORTHODONTICS, PC
Active
Organization
HAVEN ORTHODONTICS, PC
Active
Other names
Pottsville Orthodontics, PC (fictitious name)
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON MICHAEL HARTMAN D.M.D., M.S. (PRESIDENT/ORTHODONTIST)
(570) 385-1344
Entity
Organization
Contact information
Practice address
103 E MAIN ST, SCHUYLKILL HAVEN, PA 17972-1240
(570) 385-1344
Mailing address
103 E MAIN ST, SCHUYLKILL HAVEN, PA 17972-1240
(570) 385-1344
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DS038055
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023923970001
—
PA
Enumeration date
07/17/2012
Last updated
07/30/2012
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