Healthcare Provider Details
I. General information
NPI: 1497553572
Provider Name (Legal Business Name): HARTLEY AND FIELD DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 03/05/2025
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
105 SOUTH DR STE 200
MOUNTAIN VIEW CA
94040-4317
US
IV. Provider business mailing address
105 SOUTH DR STE 200
MOUNTAIN VIEW CA
94040-4317
US
V. Phone/Fax
- Phone: 650-969-2600
- Fax:
- Phone: 650-969-2600
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1223E0200X |
| Taxonomy | Endodontics |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1223G0001X |
| Taxonomy | General Practice Dentistry |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1223P0300X |
| Taxonomy | Periodontics |
| License Number | |
| License Number State | |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1223S0112X |
| Taxonomy | Oral and Maxillofacial Surgery (Dentist) |
| License Number | |
| License Number State | |
| # 5 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 1223P0700X |
| Taxonomy | Prosthodontics |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
GABY
JAMES
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 480-581-3998