Provider Demographics
NPI:1396839049
Name:HANEY, DAN THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:THOMAS
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 1:64 NW SANDY TRAIL LN
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-9558
Mailing Address - Country:US
Mailing Address - Phone:580-510-0324
Mailing Address - Fax:
Practice Address - Street 1:2776 RINGGOLD RD.
Practice Address - Street 2:USA DENTAL ACTIVITY
Practice Address - City:FT. SILL
Practice Address - State:OK
Practice Address - Zip Code:73503
Practice Address - Country:US
Practice Address - Phone:580-442-3905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2749122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist