Provider Demographics
NPI:1578801171
Name:HANEY DENTAL PLLC
Entity Type:Organization
Organization Name:HANEY DENTAL PLLC
Other - Org Name:G. BROOKS HANEY DDS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:BROOKS
Authorized Official - Last Name:HANEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-644-9595
Mailing Address - Street 1:3017 E RENNER RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-3574
Mailing Address - Country:US
Mailing Address - Phone:972-644-9595
Mailing Address - Fax:972-644-9597
Practice Address - Street 1:3017 E RENNER RD
Practice Address - Street 2:SUITE 120
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-3575
Practice Address - Country:US
Practice Address - Phone:972-644-9595
Practice Address - Fax:972-644-9597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11812122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty