Individual provider Active NPI

Ian Logan Hartl

  • Dentist
  • Cleveland, OH
National Provider Identifier
1245171446
Registry record updated May 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
6002139-15 Issued in WI
Practice address
2049 E 100TH St
Cleveland, OH 44106-2104
Phone
(216) 444-6907
NPI assigned
Apr 2, 2026
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 6002139-15 WI Primary

Addresses

Primary practice location

2049 E 100TH St
Cleveland, OH 44106-2104

Mailing address

2049 E 100TH St
Cleveland, OH 44106-2104
Phone (216) 444-6907

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260526003794 WI Order and Referring Only - DentistPractitioner - Dentist 5698245116

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6002139-15WIMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1775088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779062400000",
    "number": "1245171446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2049 E 100TH ST",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441062104",
            "telephone_number": "216-444-6907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2049 E 100TH ST",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441062104",
            "telephone_number": "216-444-6907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARTL",
        "first_name": "IAN",
        "middle_name": "LOGAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-04-02",
        "last_updated": "2026-05-18",
        "certification_date": "2026-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "6002139-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

Verify at the official NPI Registry.