Provider Demographics
NPI:1861579765
Name:HANEY, HAROLD J (DMD)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:J
Last Name:HANEY
Suffix:
Gender:M
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 OVERFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:PORT MATILDA
Mailing Address - State:PA
Mailing Address - Zip Code:16870-7105
Mailing Address - Country:US
Mailing Address - Phone:814-234-9083
Mailing Address - Fax:
Practice Address - Street 1:432 ROLLING RIDGE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7640
Practice Address - Country:US
Practice Address - Phone:814-234-0921
Practice Address - Fax:814-234-6240
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024017L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00979000Medicaid
PA00979000Medicaid
PAU17845Medicare UPIN