Provider Demographics
NPI:1700214152
Name:HASKELL DENTAL PARTNERSHIP, PLLC
Entity type:Organization
Organization Name:HASKELL DENTAL PARTNERSHIP, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHONEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:940-864-3485
Mailing Address - Street 1:PO BOX 438
Mailing Address - Street 2:
Mailing Address - City:HASKELL
Mailing Address - State:TX
Mailing Address - Zip Code:79521-0438
Mailing Address - Country:US
Mailing Address - Phone:940-864-3485
Mailing Address - Fax:940-864-3653
Practice Address - Street 1:601 S 1ST ST
Practice Address - Street 2:
Practice Address - City:HASKELL
Practice Address - State:TX
Practice Address - Zip Code:79521-5635
Practice Address - Country:US
Practice Address - Phone:940-864-3485
Practice Address - Fax:940-864-3653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty