Basic Information
| Provider Information | |||||||||
| NPI: | 1083982920 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARTLINE | ||||||||
| FirstName: | CARRIE | ||||||||
| MiddleName: | BETH | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | HYGIENIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3914 COUNTY ROAD 3110 | ||||||||
| Address2: | |||||||||
| City: | CAMPBELL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 754223244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9034569124 | ||||||||
| FaxNumber: | 9034544621 | ||||||||
| Practice Location | |||||||||
| Address1: | 3600 CADDO ST | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 754014511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9034546965 | ||||||||
| FaxNumber: | 9034547981 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2011 | ||||||||
| LastUpdateDate: | 12/07/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | 3704 | TX | Y | Dental Providers | Dental Hygienist |
No ID Information.