Provider Demographics
NPI:1235457136
Name:HAROLD R. HANEFIELD D.D.S., INC
Entity Type:Organization
Organization Name:HAROLD R. HANEFIELD D.D.S., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:HANEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-443-6692
Mailing Address - Street 1:1115 12TH ST STE 2A
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-3903
Mailing Address - Country:US
Mailing Address - Phone:916-443-6692
Mailing Address - Fax:916-443-5836
Practice Address - Street 1:1115 12TH ST STE 2A
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-3903
Practice Address - Country:US
Practice Address - Phone:916-443-6692
Practice Address - Fax:916-443-5836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24454251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management