Provider Demographics
NPI:1588635825
Name:HAIUM, JEFFREY LEE (DMD, ABGD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LEE
Last Name:HAIUM
Suffix:
Gender:M
Credentials:DMD, ABGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BLDG 9900, 2ND FLOOR
Mailing Address - Street 2:U.S. ARMY DENTAL ACTIVITY - FT LEWIS
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-0001
Mailing Address - Country:US
Mailing Address - Phone:253-968-4039
Mailing Address - Fax:253-968-5919
Practice Address - Street 1:BLDG 422
Practice Address - Street 2:U.S. ARMY DENTAL CLINIC COMMAND - POM
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93944-5810
Practice Address - Country:US
Practice Address - Phone:831-242-5612
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA285661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice