MEDICARE: DR. THALES CHRISTIAN HASKELL DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	1475	WY

General Provider Information

NPI Number	:	1194248625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THALES CHRISTIAN HASKELL DDS

Provider Business Mailing Address
First Line	:	3090 TALON DR
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82604-3279
Country	:	US
Telephone Number	:	307-237-1801
Fax Number	:	307-237-3686

Provider Business Practice Location Address
First Line	:	1001 EAGLE VIEW DR
Second Line	:
City	:	BUFFALO
State	:	WY
Zip	:	82834-1417
Country	:	US
Telephone Number	:	307-684-0119
Fax Number	:	307-684-0120

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2017
Last Update Date	:	07/21/2022

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