Provider Demographics
NPI:1538265418
Name:HARTLE, BRUCE A
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:A
Last Name:HARTLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 N MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-9557
Mailing Address - Country:US
Mailing Address - Phone:937-748-0940
Mailing Address - Fax:937-748-9406
Practice Address - Street 1:335 N MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-9557
Practice Address - Country:US
Practice Address - Phone:937-748-0940
Practice Address - Fax:937-748-9406
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH144971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice