Provider Demographics
NPI:1407955966
Name:HASELKORN, MICHAEL (D D S)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:HASELKORN
Suffix:
Gender:M
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 PATCHOGUE YAPHANK RD
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4868
Mailing Address - Country:US
Mailing Address - Phone:631-289-7755
Mailing Address - Fax:631-289-7758
Practice Address - Street 1:240 PATCHOGUE YAPHANK RD
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4868
Practice Address - Country:US
Practice Address - Phone:631-289-7755
Practice Address - Fax:631-289-7758
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0285341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice