Provider Demographics
NPI:1033696943
Name:HAILAND, ABBY R (DDS)
Entity Type:Individual
Prefix:DR
First Name:ABBY
Middle Name:R
Last Name:HAILAND
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 1:5539 PERSHING AVE APT 511
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-2136
Mailing Address - Country:US
Mailing Address - Phone:913-972-4077
Mailing Address - Fax:
Practice Address - Street 1:610 N GEYER RD
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-2756
Practice Address - Country:US
Practice Address - Phone:314-965-4064
Practice Address - Fax:314-965-1141
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018017815122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty