Provider Demographics
NPI:1194248625
Name:HASKELL, THALES CHRISTIAN (DDS)
Entity type:Individual
Prefix:DR
First Name:THALES
Middle Name:CHRISTIAN
Last Name:HASKELL
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 1:3090 TALON DR
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-3279
Mailing Address - Country:US
Mailing Address - Phone:307-237-1801
Mailing Address - Fax:307-237-3686
Practice Address - Street 1:1001 EAGLE VIEW DR
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:WY
Practice Address - Zip Code:82834-1417
Practice Address - Country:US
Practice Address - Phone:307-684-0119
Practice Address - Fax:307-684-0120
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY14751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice