Provider Demographics
NPI:1548377963
Name:HAFELE, MARIANNE (DMD)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:HAFELE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 EVERGREEN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1486
Mailing Address - Country:US
Mailing Address - Phone:502-254-8501
Mailing Address - Fax:502-245-5021
Practice Address - Street 1:2441 STATE ST
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4962
Practice Address - Country:US
Practice Address - Phone:812-941-2850
Practice Address - Fax:812-944-1602
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010580A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice