Provider Demographics
NPI:1972030534
Name:HANLEY, PETER FREEMAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:FREEMAN
Last Name:HANLEY
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 1:13295 RIVERS BEND BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-8610
Mailing Address - Country:US
Mailing Address - Phone:804-530-3539
Mailing Address - Fax:804-530-5617
Practice Address - Street 1:13295 RIVERS BEND BLVD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23836-8610
Practice Address - Country:US
Practice Address - Phone:804-530-3539
Practice Address - Fax:804-530-5617
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014156071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice