Provider Demographics
NPI:1437210705
Name:HADLEY, THOMAS LEE (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:LEE
Last Name:HADLEY
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 1:301 W. HARRISON ST.
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IN
Mailing Address - Zip Code:47960-2211
Mailing Address - Country:US
Mailing Address - Phone:574-583-8060
Mailing Address - Fax:574-583-5644
Practice Address - Street 1:301 W. HARRISON ST.
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IN
Practice Address - Zip Code:47960-2211
Practice Address - Country:US
Practice Address - Phone:574-583-8060
Practice Address - Fax:574-583-5644
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008312122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist