MEDICARE: DR. TERRY JOHN HANLEY D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	AZ2518	AZ

General Provider Information

NPI Number	:	1558304121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRY JOHN HANLEY D.M.D.

Provider Business Mailing Address
First Line	:	1050 E SOUTHERN AVE
Second Line	:	SUITE #6
City	:	TEMPE
State	:	AZ
Zip	:	85282-5403
Country	:	US
Telephone Number	:	480-829-1466
Fax Number	:	480-829-1467

Provider Business Practice Location Address
First Line	:	1050 E SOUTHERN AVE
Second Line	:	SUITE #6
City	:	TEMPE
State	:	AZ
Zip	:	85282-5403
Country	:	US
Telephone Number	:	480-829-1466
Fax Number	:	480-829-1467

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	07/08/2007

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