=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164631388
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRUCE HANLEY, DDS AND ASSOCIATES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2501 N GLEBE RD SUITE #200
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22207-3558
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-524-7100
-----------------------------------------------------
Fax | 703-524-3523
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2501 N GLEBE RD SUITE #200
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22207-3558
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-524-7100
-----------------------------------------------------
Fax | 703-524-3523
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. BRUCE HANLEY
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 703-524-7100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 0401006818
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------