Healthcare Provider Details

I. General information

NPI: 1356508931
Provider Name (Legal Business Name): DAVID LLOYD HADLEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10429 LAGRIMA DE ORO RD NE
ALBUQUERQUE NM
87111-3727
US

IV. Provider business mailing address

10429 LAGRIMA DE ORO RD NE
ALBUQUERQUE NM
87111-3727
US

V. Phone/Fax

Practice location:
  • Phone: 505-291-8630
  • Fax:
Mailing address:
  • Phone: 505-291-8630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDD2993
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number0401411226
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: