Provider Demographics
NPI:1558318493
Name:HASKINS, DONALD WOOD (DDS)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:WOOD
Last Name:HASKINS
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 1:5222 N PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112
Mailing Address - Country:US
Mailing Address - Phone:405-947-1525
Mailing Address - Fax:405-947-6716
Practice Address - Street 1:5222 N PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OR
Practice Address - Zip Code:73112
Practice Address - Country:US
Practice Address - Phone:405-947-1525
Practice Address - Fax:405-947-6716
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK29331223P0221X
TX72651223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100104200AMedicaid