Provider Demographics
NPI:1760641625
Name:HASELOFF, ANDREA BETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:BETH
Last Name:HASELOFF
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:BETH
Other - Last Name:SARGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:4320 LAURIE MICHELLE RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78261-1821
Mailing Address - Country:US
Mailing Address - Phone:830-308-5567
Mailing Address - Fax:
Practice Address - Street 1:2940 STANLEY RD STE 2375
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78234-2740
Practice Address - Country:US
Practice Address - Phone:210-295-4095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX316301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice