Healthcare Provider Details

I. General information

NPI: 1356302046
Provider Name (Legal Business Name): CHARLOTTE A HANEY D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE STREET RM D104 UNIVERSITY OF KENTUCKY COLLEGE OF DENTISTRY
LEXINGTON KY
40536-0297
US

IV. Provider business mailing address

800 ROSE STREET RM D104 UNIVERSITY OF KENTUCKY COLLEGE OF DENTISTRY
LEXINGTON KY
40536-0297
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-9707
  • Fax: 859-257-5859
Mailing address:
  • Phone: 859-323-9707
  • Fax: 859-257-5859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number4592
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number4592
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: