Provider Demographics
NPI:1043430978
Name:HARTLEY, MICHAEL CLIFFORD (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CLIFFORD
Last Name:HARTLEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2808 ROYAL ISLE DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-4083
Mailing Address - Country:US
Mailing Address - Phone:850-668-5587
Mailing Address - Fax:850-386-8181
Practice Address - Street 1:1305 THOMASWOOD DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-7915
Practice Address - Country:US
Practice Address - Phone:850-386-2400
Practice Address - Fax:850-386-8181
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0015170122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist