Healthcare Provider Details

I. General information

NPI: 1235161647
Provider Name (Legal Business Name): RICHARD JOSEPH HALEY DDS BA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 05/25/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 HOSPITAL DR STE A
CARRIZO SPRINGS TX
78834-3847
US

IV. Provider business mailing address

504 HOSPITAL DR STE A
CARRIZO SPRINGS TX
78834-3847
US

V. Phone/Fax

Practice location:
  • Phone: 830-255-1684
  • Fax: 830-255-1684
Mailing address:
  • Phone: 830-255-1684
  • Fax: 830-255-1684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number16503
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number16503
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: