Provider Demographics
NPI:1588365894
Name:WAHPETON FAMILY DENTISTRY
Entity type:Organization
Organization Name:WAHPETON FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF DENTAL SURGERY
Authorized Official - Prefix:DR
Authorized Official - First Name:MASON
Authorized Official - Middle Name:
Authorized Official - Last Name:HALEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-302-0670
Mailing Address - Street 1:103 9TH ST N
Mailing Address - Street 2:
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58075-4343
Mailing Address - Country:US
Mailing Address - Phone:701-302-0670
Mailing Address - Fax:
Practice Address - Street 1:103 9TH ST N
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075-4343
Practice Address - Country:US
Practice Address - Phone:701-302-0670
Practice Address - Fax:701-642-1111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty