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General NPI Number Information
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NPI Number | 1831313840
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Entity Type | Individual
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Provider Name | JOHN CARLISLE HALEY DDS
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Gender | Male
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10225 ULMERTON ROAD SUITE 4 C
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City | LARGO
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State | FL
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Zip | 33771-3520
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Country | US
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Telephone | 727-585-6658
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Fax | 727-586-7576
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Provider Business Mailing Address
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Address Line | 17541 2ND STREET EAST
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City | REDINGTON SHORES
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State | FL
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Zip | 33708-1225
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Country | US
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Telephone | 727-397-6297
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 9619
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License Number State | FL
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