Provider Demographics
NPI:1053644104
Name:HALEY, PARKER JOHN COLMENARES (DDS)
Entity Type:Individual
Prefix:DR
First Name:PARKER JOHN
Middle Name:COLMENARES
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 1:1100 ELLIS ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-5238
Mailing Address - Country:US
Mailing Address - Phone:360-734-6190
Mailing Address - Fax:
Practice Address - Street 1:1100 ELLIS ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5238
Practice Address - Country:US
Practice Address - Phone:360-734-6190
Practice Address - Fax:360-733-2120
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59383122300000X
WADE60099952122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist