Individual
DOUGLAS MICHAEL HARTLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
411 N PERU ST, CICERO, IN 46034-9498
(317) 984-3531
Mailing address
411 N PERU ST, CICERO, IN 46034-9498
(317) 984-3531
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12012274A
IN
Other
Enumeration date
06/01/2012
Last updated
12/21/2020
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