Provider Demographics
NPI:1164288460
Name:HARTLLEY, RITA JEAN (DMD)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:JEAN
Last Name:HARTLLEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9111 NE SUNDERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-1708
Mailing Address - Country:US
Mailing Address - Phone:503-280-6646
Mailing Address - Fax:
Practice Address - Street 1:9111 NE SUNDERLAND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-1708
Practice Address - Country:US
Practice Address - Phone:503-280-6646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD79781223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health