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General NPI Number Information
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NPI Number | 1235457136
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Entity Type | Organization
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Legal Business Name | HAROLD R. HANEFIELD D.D.S., INC
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Dates
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Enumeration Date | 05/17/2010
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Last Update Date | 05/17/2010
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Provider Practice Location Address
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Address Line | 1115 12TH ST STE 2A
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City | SACRAMENTO
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State | CA
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Zip | 95814-3903
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Country | US
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Telephone | 916-443-6692
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Fax | 916-443-5836
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Provider Business Mailing Address
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Address Line | 1115 12TH ST STE 2A
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City | SACRAMENTO
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State | CA
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Zip | 95814-3903
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Country | US
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Telephone | 916-443-6692
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Fax | 916-443-5836
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HAROLD RICHARD HANEFIELD
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Credential | D.D.S
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Telephone | 916-443-6692
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 24454
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License Number State | CA
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