NPIMap

Organization Active NPI

Earl B Hartzog DMD PA

Doing business as Denmark Dentistry

  • Dentist
  • Denmark, SC
National Provider Identifier
1093047896
Registry record updated Sep 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
4591 Issued in SC
Legal business name
EARL B HARTZOG DMD PA
Doing business as
Denmark Dentistry
Practice address
17652 Heritage Hwy
Denmark, SC 29042-1469
Phone
(803) 793-3653
Fax
(803) 753-9777
NPI assigned
Feb 3, 2010
Last updated
Sep 13, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Earl B Hartzog, DMDNPI 1881820637
Title
President
Phone
(843) 560-0639

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 4591 SC Primary

Addresses

Primary practice location

17652 Heritage Hwy
Denmark, SC 29042-1469

Mailing address

17652 Heritage Hwy
Denmark, SC 29042-1469
Phone (803) 793-3653

Other practice location 1

174 Beech Ave
Denmark, SC 29042
Phone (803) 793-3653

Other identifiers 1

IdentifierTypeStateIssuer
ZX4591MedicaidSC

Other names 1

  • Denmark Dentistry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Earl B Hartzog DMD PA8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

17652 Heritage Hwy
Denmark, SC 29042
Phone (803) 793-3653

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1265155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663027200000",
    "number": "1093047896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17652 HERITAGE HWY",
            "city": "DENMARK",
            "state": "SC",
            "postal_code": "290421469",
            "telephone_number": "803-793-3653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17652 HERITAGE HWY",
            "city": "DENMARK",
            "state": "SC",
            "postal_code": "290421469",
            "telephone_number": "803-793-3653",
            "fax_number": "803-753-9777"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "174 Beech Ave",
            "address_purpose": "LOCATION",
            "city": "Denmark",
            "state": "SC",
            "postal_code": "29042",
            "country_code": "US",
            "telephone_number": "803-793-3653",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EARL B HARTZOG DMD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-03",
        "last_updated": "2022-09-13",
        "certification_date": "2022-09-13",
        "status": "A",
        "authorized_official_last_name": "HARTZOG",
        "authorized_official_first_name": "EARL",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "843-560-0639",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "SC",
            "license": "4591",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZX4591",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Denmark Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Denmark Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Denmark, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.