Healthcare Provider Details

I. General information

NPI: 1427072438
Provider Name (Legal Business Name): MARK AARON HASKELL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 SW 2ND AVE
CANBY OR
97013-4152
US

IV. Provider business mailing address

146 SW 2ND AVE
CANBY OR
97013-4152
US

V. Phone/Fax

Practice location:
  • Phone: 503-266-5596
  • Fax:
Mailing address:
  • Phone: 503-266-5596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD8417
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: