Organization
LOREN R. HARTLEY, D.M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOREN R. HARTLEY D.M.D. (PRESIDENT)
(208) 466-6600
Entity
Organization
Contact information
Practice address
1705 12TH AVE RD, NAMPA, ID 83686-6104
(208) 466-6600
(208) 466-6603
Mailing address
1705 12TH AVE RD, NAMPA, ID 83686-6104
(208) 466-6600
(208) 466-6603
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805216200
—
ID
Enumeration date
07/18/2008
Last updated
07/18/2008
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