Provider Demographics
NPI:1205451952
Name:DOOSE, HALEY L
Entity type:Individual
Prefix:DR
First Name:HALEY
Middle Name:L
Last Name:DOOSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 HANCOCK GREEN PL UNIT 101
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1948
Mailing Address - Country:US
Mailing Address - Phone:270-780-4031
Mailing Address - Fax:
Practice Address - Street 1:324 W 2ND ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2199
Practice Address - Country:US
Practice Address - Phone:812-522-8608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN123456789122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist