Provider Demographics
NPI:1861539066
Name:HASLAM, CODY W (DDS)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:W
Last Name:HASLAM
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 1:3475 COOK AVENUE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3307 GRAND AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6546
Practice Address - Country:US
Practice Address - Phone:406-652-7313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT21101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice