NPIMap

Organization Active NPI

Earl B Hartzog DMD PA

  • Dentist
  • Bamberg, SC
National Provider Identifier
1114202736
Registry record updated Oct 14, 2011
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
Practice address
474 North St
Bamberg, SC 29003-1318
Phone
(803) 245-5545
Fax
(803) 245-5534
NPI assigned
Oct 14, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2011

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

Authorized official

Name
Dr. Earl Barrett Hartzog, DMD
Title
President
Phone
(803) 245-5545

Specialties & licenses 1

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

Addresses

Primary practice location

474 North St
Bamberg, SC 29003-1318

Mailing address

474 North St
Bamberg, SC 29003-1318
Phone (803) 245-5545

Other identifiers 1

IdentifierTypeStateIssuer
ZX4591MedicaidSC

Other names 1

  • Bamberg 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

474 North St
Bamberg, SC 29003
Phone (803) 245-5545

NPI Registry JSON

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

{
    "created_epoch": "1318550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318550400000",
    "number": "1114202736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "474 NORTH ST",
            "city": "BAMBERG",
            "state": "SC",
            "postal_code": "290031318",
            "telephone_number": "803-245-5545",
            "fax_number": "803-245-5534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "474 NORTH ST",
            "city": "BAMBERG",
            "state": "SC",
            "postal_code": "290031318",
            "telephone_number": "803-245-5545",
            "fax_number": "803-245-5534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EARL B HARTZOG DMD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-14",
        "last_updated": "2011-10-14",
        "status": "A",
        "authorized_official_last_name": "HARTZOG",
        "authorized_official_first_name": "EARL",
        "authorized_official_middle_name": "BARRETT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "803-245-5545",
        "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": "Bamberg Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bamberg, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2011; 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.