Provider Demographics
NPI:1487623849
Name:HASELTON, DEBRA R (DDS)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:R
Last Name:HASELTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3721 WESTERRE PKWY
Mailing Address - Street 2:SUITE D
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1332
Mailing Address - Country:US
Mailing Address - Phone:804-935-5631
Mailing Address - Fax:804-935-5632
Practice Address - Street 1:3721 WESTERRE PKWY
Practice Address - Street 2:SUITE D
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-1332
Practice Address - Country:US
Practice Address - Phone:804-935-5631
Practice Address - Fax:804-935-5632
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010079101223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010086647Medicaid