Provider Demographics
NPI:1962763169
Name:XU, HAIFENG (DDS, PHD)
Entity type:Individual
Prefix:
First Name:HAIFENG
Middle Name:
Last Name:XU
Suffix:
Gender:F
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14536 STONEGATE CT
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-9132
Mailing Address - Country:US
Mailing Address - Phone:317-771-3303
Mailing Address - Fax:
Practice Address - Street 1:29 E MCCARTY ST
Practice Address - Street 2:STE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46225-3326
Practice Address - Country:US
Practice Address - Phone:317-602-4898
Practice Address - Fax:317-559-7159
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012273A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice