Provider Demographics
NPI:1770750325
Name:HALLER, STAYNER (DDS)
Entity type:Individual
Prefix:
First Name:STAYNER
Middle Name:
Last Name:HALLER
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 1:1322 E MICHIGAN AVE
Mailing Address - Street 2:SPARROW MEDICAL ARTS BUILDING SUITE 302
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-2176
Mailing Address - Country:US
Mailing Address - Phone:517-484-4515
Mailing Address - Fax:
Practice Address - Street 1:1322 E MICHIGAN AVE
Practice Address - Street 2:SPARROW MEDICAL ARTS BUILING SUITE 302
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-2176
Practice Address - Country:US
Practice Address - Phone:517-484-4515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI83971223E0200X
MIE221223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics