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General NPI Number Information
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NPI Number | 1396518726
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Entity Type | Individual
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Provider Name | CHAD MICHAEL HARTLEY DMD
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Gender | Male
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Dates
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Enumeration Date | 11/07/2023
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Last Update Date | 06/14/2025
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Provider Practice Location Address
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Address Line | 7040 OLD CANTON RD
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City | RIDGELAND
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State | MS
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Zip | 39157-1035
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Country | US
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Telephone | 186-460-1790
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Fax |
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Provider Business Mailing Address
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Address Line | 46 BOGARD ST APT A
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City | CHARLESTON
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State | SC
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Zip | 29403-5367
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Country | US
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Telephone | 251-232-4100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 4489-24
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License Number State | MS
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