Provider Demographics
NPI:1538274188
Name:HALEY, JAMES ALBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALBERT
Last Name:HALEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:ALBERT
Other - Last Name:HALEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3190 DAVIE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-2729
Mailing Address - Country:US
Mailing Address - Phone:954-581-3645
Mailing Address - Fax:954-581-4387
Practice Address - Street 1:3190 DAVIE BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-2729
Practice Address - Country:US
Practice Address - Phone:954-581-3645
Practice Address - Fax:954-581-4387
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL41041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice