Provider Demographics
NPI:1073515417
Name:HANEY, SCOTT CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:CHARLES
Last Name:HANEY
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 1:12367 E DEL RICO
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85367-7364
Mailing Address - Country:US
Mailing Address - Phone:928-345-9598
Mailing Address - Fax:
Practice Address - Street 1:1175 HART ST.
Practice Address - Street 2:MCAS YUMA BRANCH DENTAL CLINIC
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85369
Practice Address - Country:US
Practice Address - Phone:928-269-2353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD94821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice