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General NPI Number Information
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NPI Number | 1154586196
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Entity Type | Organization
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Legal Business Name | LOREN R. HARTLEY, D.M.D., P.C.
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Dates
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Enumeration Date | 07/18/2008
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Last Update Date | 07/18/2008
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Provider Practice Location Address
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Address Line | 1705 12TH AVE RD
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City | NAMPA
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State | ID
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Zip | 83686-6104
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Country | US
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Telephone | 208-466-6600
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Fax | 208-466-6603
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Provider Business Mailing Address
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Address Line | 1705 12TH AVE RD
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City | NAMPA
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State | ID
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Zip | 83686-6104
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Country | US
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Telephone | 208-466-6600
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Fax | 208-466-6603
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Authorized Official
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Title or Position | PRESIDENT
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Name | LOREN R. HARTLEY
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Credential | D.M.D.
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Telephone | 208-466-6600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State | ID
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