Provider Demographics
NPI:1265572010
Name:HASSEBROEK, DAVID DON (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:DON
Last Name:HASSEBROEK
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:PO BOX 417
Mailing Address - Street 2:
Mailing Address - City:CASTLETON
Mailing Address - State:VT
Mailing Address - Zip Code:05735-0417
Mailing Address - Country:US
Mailing Address - Phone:802-468-5478
Mailing Address - Fax:802-468-3261
Practice Address - Street 1:RT. 30 CASTLETON FOUR CORNERS
Practice Address - Street 2:
Practice Address - City:CASTLETON
Practice Address - State:VT
Practice Address - Zip Code:05735-0417
Practice Address - Country:US
Practice Address - Phone:802-468-5478
Practice Address - Fax:802-468-3261
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT9171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice