NPIMap

Organization Active NPI

Earl B Hartzog DMD PA

Doing business as Estill Dentistry

  • General Practice Dentistry
  • Estill, SC
National Provider Identifier
1689001034
Registry record updated Oct 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4591 Issued in SC
Legal business name
EARL B HARTZOG DMD PA
Doing business as
Estill Dentistry
Practice address
123 Catherine Avenue North
Estill, SC 29918
Phone
(803) 625-3640
Fax
(803) 625-4382
NPI assigned
Oct 1, 2013
Last updated
Oct 1, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2013

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
(803) 793-3653

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 4591 SC Primary

Addresses

Primary practice location

123 Catherine Avenue North
Estill, SC 29918

Mailing address

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

Other names 1

  • Estill 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

123 Catherine St N
Estill, SC 29918
Phone (803) 625-3640

Practitioners & affiliated clinicians

Practitioners 1

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": "1380585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380585600000",
    "number": "1689001034",
    "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": "123 CATHERINE AVENUE NORTH",
            "city": "ESTILL",
            "state": "SC",
            "postal_code": "29918",
            "telephone_number": "803-625-3640",
            "fax_number": "803-625-4382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EARL B HARTZOG DMD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-01",
        "last_updated": "2013-10-01",
        "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": "803-793-3653",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "4591",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Estill Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Estill, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2013; 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.