Provider Demographics
NPI:1164631388
Name:BRUCE HANLEY, DDS AND ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:BRUCE HANLEY, DDS AND ASSOCIATES, PLLC
Other - Org Name:BRUCE HANLEY, DDS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-524-7100
Mailing Address - Street 1:2501 N GLEBE RD
Mailing Address - Street 2:SUITE #200
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-3558
Mailing Address - Country:US
Mailing Address - Phone:703-524-7100
Mailing Address - Fax:703-524-3523
Practice Address - Street 1:2501 N GLEBE RD
Practice Address - Street 2:SUITE #200
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207-3558
Practice Address - Country:US
Practice Address - Phone:703-524-7100
Practice Address - Fax:703-524-3523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006818261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1427097161OtherINDIVIDUAL NPI