Provider Demographics
NPI:1124147830
Name:HASLAM, STEPHEN D (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:D
Last Name:HASLAM
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 1:6065 FASHION BLVD
Mailing Address - Street 2:SUITE 275
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-7381
Mailing Address - Country:US
Mailing Address - Phone:801-262-4628
Mailing Address - Fax:801-262-9260
Practice Address - Street 1:6065 FASHION BLVD
Practice Address - Street 2:SUITE 275
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7381
Practice Address - Country:US
Practice Address - Phone:801-262-4628
Practice Address - Fax:801-262-9260
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT143673-99231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice