MEDICARE: DR. JEFFERY WILLIAM HADLEY DDS

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	122300000X	Dentist	2981	NV

General Provider Information

NPI Number	:	1649277252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFERY WILLIAM HADLEY DDS

Provider Business Mailing Address
First Line	:	299 FAIRMEADOW ST
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89012-3292
Country	:	US
Telephone Number	:	702-263-4768
Fax Number	:	702-454-4875

Provider Business Practice Location Address
First Line	:	3910 PECOS MCLEOD
Second Line	:	STE A140
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-7443
Country	:	US
Telephone Number	:	702-454-7695
Fax Number	:	702-454-4875

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

Provider Enumeration Date	:	06/29/2005
Last Update Date	:	07/08/2007

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