Provider Demographics
NPI:1437366960
Name:HAVENER, DARRELL L (DDS)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:L
Last Name:HAVENER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1420 W CANAL CT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-5655
Mailing Address - Country:US
Mailing Address - Phone:303-791-2021
Mailing Address - Fax:303-791-0327
Practice Address - Street 1:1420 W CANAL CT
Practice Address - Street 2:SUITE 200
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-5655
Practice Address - Country:US
Practice Address - Phone:303-791-2021
Practice Address - Fax:303-791-0327
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO51181223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics