Provider Demographics
NPI:1013010339
Name:HANEY, HOWARD WAYNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:WAYNE
Last Name:HANEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7354
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-7354
Mailing Address - Country:US
Mailing Address - Phone:843-665-4344
Mailing Address - Fax:843-665-4619
Practice Address - Street 1:417 W CHEVES ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4446
Practice Address - Country:US
Practice Address - Phone:843-665-4344
Practice Address - Fax:843-665-4619
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ17410Medicaid
SC204535635Medicare UPIN