Provider Demographics
NPI:1487854808
Name:HAFFNER, JOHN JASON (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JASON
Last Name:HAFFNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3480 KEITH BRIDGE RD
Mailing Address - Street 2:SUITE A-4
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-5568
Mailing Address - Country:US
Mailing Address - Phone:770-292-9441
Mailing Address - Fax:770-292-9442
Practice Address - Street 1:3480 KEITH BRIDGE RD
Practice Address - Street 2:SUITE A-4
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-5568
Practice Address - Country:US
Practice Address - Phone:770-292-9441
Practice Address - Fax:770-292-9442
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA4420000641223P0221X
GADNO135201223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA189864465Medicaid