Provider Demographics
NPI:1134386899
Name:HALEY, JOHN PATRICK III (DMD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PATRICK
Last Name:HALEY
Suffix:III
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 1:18467 POINT CLEAR CT
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-6847
Mailing Address - Country:US
Mailing Address - Phone:251-928-5383
Mailing Address - Fax:
Practice Address - Street 1:18467 POINT CLEAR CT
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-6847
Practice Address - Country:US
Practice Address - Phone:251-928-5383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL28051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice