# LOREN R. HARTLEY, D.M.D., P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154586196
- **Authorized official:** LOREN R. HARTLEY D.M.D. (PRESIDENT)
- **Authorized official phone:** (208) 466-6600

## Contact information

- **Practice address:** 1705 12TH AVE RD, NAMPA, ID 83686-6104
- **Practice address phone:** (208) 466-6600
- **Practice address fax:** (208) 466-6603
- **Mailing address:** 1705 12TH AVE RD, NAMPA, ID 83686-6104
- **Mailing address phone:** (208) 466-6600
- **Mailing address fax:** (208) 466-6603

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | ID | Yes |

## Other

- **Enumeration date:** 07/18/2008
- **Last updated:** 07/18/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 805216200 | — | ID |