Provider Demographics
NPI:1730385097
Name:HAFKE, JAMIE L (DDS)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:HAFKE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 N PONTIAC TRL
Mailing Address - Street 2:
Mailing Address - City:WALLED LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-3157
Mailing Address - Country:US
Mailing Address - Phone:248-669-2311
Mailing Address - Fax:248-669-5858
Practice Address - Street 1:1955 N. PONTIAC TRAIL
Practice Address - Street 2:
Practice Address - City:WALLED LAKE
Practice Address - State:MI
Practice Address - Zip Code:48390
Practice Address - Country:US
Practice Address - Phone:248-669-2311
Practice Address - Fax:248-669-5858
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI15655122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist