Provider Demographics
NPI:1710473244
Name:HASELOFF, NATALIE MOUZON (DMD)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:MOUZON
Last Name:HASELOFF
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:MOUZON
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:5609 COUNTY ROAD 1440
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-5785
Mailing Address - Country:US
Mailing Address - Phone:806-789-5275
Mailing Address - Fax:
Practice Address - Street 1:11824 INDIANA AVE STE 200
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-1884
Practice Address - Country:US
Practice Address - Phone:806-702-7620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX339671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice