Provider Demographics
NPI:1760582787
Name:HARTLEY, BRUCE WOOD (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:WOOD
Last Name:HARTLEY
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 1:1000 FREMONT AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-6093
Mailing Address - Country:US
Mailing Address - Phone:650-948-5524
Mailing Address - Fax:650-948-1887
Practice Address - Street 1:1000 FREMONT AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-6093
Practice Address - Country:US
Practice Address - Phone:650-948-5524
Practice Address - Fax:650-948-1887
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist