Provider Demographics
NPI:1831313840
Name:HALEY, JOHN CARLISLE (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CARLISLE
Last Name:HALEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17541 2ND STREET EAST
Mailing Address - Street 2:
Mailing Address - City:REDINGTON SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33708-1225
Mailing Address - Country:US
Mailing Address - Phone:727-397-6297
Mailing Address - Fax:
Practice Address - Street 1:10225 ULMERTON ROAD
Practice Address - Street 2:SUITE 4 C
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-3520
Practice Address - Country:US
Practice Address - Phone:727-585-6658
Practice Address - Fax:727-586-7576
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9619122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist