Provider Demographics
NPI:1033896790
Name:ROZEBOOM, HALEY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:HALEY
Middle Name:L
Last Name:ROZEBOOM
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 1:6122 E COPPER PLACE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57110
Mailing Address - Country:US
Mailing Address - Phone:712-395-2684
Mailing Address - Fax:
Practice Address - Street 1:4921 E 26TH ST STE 1
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57110-6965
Practice Address - Country:US
Practice Address - Phone:160-537-1344
Practice Address - Fax:605-371-3445
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD1405122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist