Provider Demographics
NPI:1760813596
Name:HALEY, MARK V (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:V
Last Name:HALEY
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 1:6345 E BELL RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-6452
Mailing Address - Country:US
Mailing Address - Phone:480-607-3600
Mailing Address - Fax:480-998-9289
Practice Address - Street 1:6345 E BELL RD
Practice Address - Street 2:SUITE 1
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6452
Practice Address - Country:US
Practice Address - Phone:480-607-3600
Practice Address - Fax:480-998-9289
Is Sole Proprietor?:No
Enumeration Date:2013-12-04
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice