Provider Demographics
NPI:1114069754
Name:HACKNEY, ROBERT DUANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DUANE
Last Name:HACKNEY
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:PO BOX 398
Mailing Address - Street 2:615 W ALDER ST
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:95584
Mailing Address - Country:US
Mailing Address - Phone:360-426-1676
Mailing Address - Fax:360-427-4303
Practice Address - Street 1:615 W ALDER ST
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:95584
Practice Address - Country:US
Practice Address - Phone:360-426-1676
Practice Address - Fax:360-427-4303
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3157122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist