MEDICARE: TODD HASKIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	103756	AK

General Provider Information

NPI Number	:	1396112835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD HASKIN

Provider Business Mailing Address
First Line	:	1060 GAFFNEY RD
Second Line	:	#1055
City	:	FT WAINWRIGHT
State	:	AK
Zip	:	99703-5002
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1060 GAFFNEY RD
Second Line	:	#1055
City	:	FT WAINWRIGHT
State	:	AK
Zip	:	99703-5002
Country	:	US
Telephone Number	:	907-361-5515
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2015
Last Update Date	:	09/01/2015

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Directions to “ TODD HASKIN ” Practice Location

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