MEDICARE: DR. BRUCE HANLEY D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	0401006818	VA
2	1223G0001X	General Practice Dentistry	DEN4546	DC
3	1223G0001X	General Practice Dentistry	8462	MD

General Provider Information

NPI Number	:	1427097161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE HANLEY D.D.S

Provider Business Mailing Address
First Line	:	2501 N GLEBE RD
Second Line	:	#200
City	:	ARLINGTON
State	:	VA
Zip	:	22207-3558
Country	:	US
Telephone Number	:	703-524-7100
Fax Number	:	703-524-3523

Provider Business Practice Location Address
First Line	:	2501 N GLEBE RD
Second Line	:	#200
City	:	ARLINGTON
State	:	VA
Zip	:	22207-3558
Country	:	US
Telephone Number	:	703-524-7100
Fax Number	:	703-524-3523

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	07/08/2007

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