Provider Demographics
NPI:1730125394
Name:HAXTON, JOHN PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PAUL
Last Name:HAXTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 NORTH MUSEUM BLVD.
Mailing Address - Street 2:APT. 702
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061
Mailing Address - Country:US
Mailing Address - Phone:847-732-6723
Mailing Address - Fax:
Practice Address - Street 1:FISHER CLINIC, 2410 SAMPSON ST.
Practice Address - Street 2:BLDG 237
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088-5230
Practice Address - Country:US
Practice Address - Phone:847-688-3331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6618122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist