Provider Demographics
NPI:1013186998
Name:HALEY, THOMAS MAXWELL (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:MAXWELL
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 1:214 ENGLAND ST
Mailing Address - Street 2:P.O. BOX 928
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-2075
Mailing Address - Country:US
Mailing Address - Phone:804-798-8121
Mailing Address - Fax:804-798-2777
Practice Address - Street 1:214 ENGLAND ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-2075
Practice Address - Country:US
Practice Address - Phone:804-798-8121
Practice Address - Fax:804-798-2777
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA69351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice