Provider Demographics
NPI:1063511277
Name:BRUCE A HARTLE DDS DC CO
Entity type:Organization
Organization Name:BRUCE A HARTLE DDS DC CO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:937-746-3333
Mailing Address - Street 1:512 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:OH
Mailing Address - Zip Code:45005-3328
Mailing Address - Country:US
Mailing Address - Phone:937-746-3333
Mailing Address - Fax:937-743-9554
Practice Address - Street 1:512 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:OH
Practice Address - Zip Code:45005-3328
Practice Address - Country:US
Practice Address - Phone:937-746-3333
Practice Address - Fax:937-743-9554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH144971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty