Provider Demographics
NPI:1891858122
Name:HARTLEY, TIMOTHY E (DDS)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:E
Last Name:HARTLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 379
Mailing Address - Street 2:
Mailing Address - City:SLINGER
Mailing Address - State:WI
Mailing Address - Zip Code:53086-0379
Mailing Address - Country:US
Mailing Address - Phone:262-644-6951
Mailing Address - Fax:262-644-6825
Practice Address - Street 1:410 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SLINGER
Practice Address - State:WI
Practice Address - Zip Code:53086-9650
Practice Address - Country:US
Practice Address - Phone:262-644-6951
Practice Address - Fax:262-644-6825
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3137OtherDELTA
WI33451600Medicaid