Individual
LOREN ROSS HARTLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1705 12TH AVE RD, NAMPA, ID 83686
(208) 466-6600
(208) 466-6421
Mailing address
1705 12TH AVE RD, NAMPA, ID 83686
(208) 466-6600
(208) 466-6421
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3288
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D8677
BOARD OF DENTISTRY
OR
Enumeration date
10/16/2006
Last updated
07/08/2007
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