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General NPI Number Information
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NPI Number | 1003502832
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Entity Type | Individual
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Provider Name | HALEY KI'LES VANN
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Gender | Female
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Dates
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Enumeration Date | 04/14/2023
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Last Update Date | 12/27/2025
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Provider Practice Location Address
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Address Line | 1710 SARDIS RD N
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City | CHARLOTTE
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State | NC
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Zip | 28270-2405
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Country | US
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Telephone | 843-754-8548
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Fax |
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Provider Business Mailing Address
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Address Line | 5105 MALVASIA CT
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City | SUMMERVILLE
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State | SC
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Zip | 29485-8954
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 13277
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License Number State | NC
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