Healthcare Provider Details

I. General information

NPI: 1275640096
Provider Name (Legal Business Name): BRUCE A HARTLE DDS DC CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 N MAIN ST SUITE 1
SPRINGBORO OH
45066-9557
US

IV. Provider business mailing address

335 N MAIN ST SUITE 1
SPRINGBORO OH
45066-9557
US

V. Phone/Fax

Practice location:
  • Phone: 937-748-0940
  • Fax: 937-748-1666
Mailing address:
  • Phone: 937-748-0940
  • Fax: 937-748-1666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1228
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14497
License Number StateOH

VIII. Authorized Official

Name: DR. BRUCE A HARTLE
Title or Position: OWNER
Credential: DDS
Phone: 937-748-0940