Provider Demographics
NPI:1760121842
Name:HALEY DENTAL CORP
Entity Type:Organization
Organization Name:HALEY DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WONSUK
Authorized Official - Middle Name:
Authorized Official - Last Name:JOO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:857-364-1566
Mailing Address - Street 1:4 LUCY ST APT C613
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02125-2697
Mailing Address - Country:US
Mailing Address - Phone:857-364-1566
Mailing Address - Fax:
Practice Address - Street 1:1242 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-4045
Practice Address - Country:US
Practice Address - Phone:781-762-3529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty