Provider Demographics
NPI:1306095534
Name:HATLEY FAMILY DENTISTRY
Entity type:Organization
Organization Name:HATLEY FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:HATLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-225-4128
Mailing Address - Street 1:9501 N RODNEY PARHAM RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227-6207
Mailing Address - Country:US
Mailing Address - Phone:501-225-4128
Mailing Address - Fax:501-225-6819
Practice Address - Street 1:9501 N RODNEY PARHAM RD
Practice Address - Street 2:SUITE 5
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72227-6207
Practice Address - Country:US
Practice Address - Phone:501-225-4128
Practice Address - Fax:501-225-6819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty