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General NPI Number Information
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NPI Number | 1912522103
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Entity Type | Individual
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Provider Name | JARRED M. HANLEY DMD
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Gender | Male
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Dates
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Enumeration Date | 06/12/2020
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 7136 PAV WAY
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-2264
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Country | US
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Telephone | 928-775-9495
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Fax |
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Provider Business Mailing Address
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Address Line | 6796 S LANGDALE ST UNIT 204
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City | AURORA
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State | CO
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Zip | 80016-2875
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Country | US
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Telephone |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D011041
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License Number State | AZ
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