Provider Demographics
NPI:1639716574
Name:TODD HASKIN DMD LLC
Entity Type:Organization
Organization Name:TODD HASKIN DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:HASKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:907-452-8296
Mailing Address - Street 1:360 OLD CHENA PUMP RD STE A
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-2936
Mailing Address - Country:US
Mailing Address - Phone:907-452-8296
Mailing Address - Fax:
Practice Address - Street 1:360 OLD CHENA PUMP RD STE A
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-2936
Practice Address - Country:US
Practice Address - Phone:907-452-8296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty