Provider Demographics
NPI:1124245725
Name:HANEY, GEORGE BROOKS (DDS)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:BROOKS
Last Name:HANEY
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 1:2400 LAKESIDE BLVD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-4341
Mailing Address - Country:US
Mailing Address - Phone:972-644-9595
Mailing Address - Fax:972-644-9597
Practice Address - Street 1:2400 LAKESIDE BLVD
Practice Address - Street 2:SUITE 700
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-4341
Practice Address - Country:US
Practice Address - Phone:972-644-9595
Practice Address - Fax:972-644-9597
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice