Provider Demographics
NPI:1154503548
Name:JACK W. HANEY, D.D.S., P.C.
Entity Type:Organization
Organization Name:JACK W. HANEY, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:W
Authorized Official - Last Name:HANEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:865-693-6886
Mailing Address - Street 1:117 HUXLEY RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3179
Mailing Address - Country:US
Mailing Address - Phone:865-693-6886
Mailing Address - Fax:865-693-0891
Practice Address - Street 1:117 HUXLEY RD
Practice Address - Street 2:SUITE C
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3179
Practice Address - Country:US
Practice Address - Phone:865-693-6886
Practice Address - Fax:865-693-0891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS72871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty