MEDICARE: DR. WILLIAM ROBERT HAUN SR. D.D.S.

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	04425	VA

General Provider Information

NPI Number	:	1316966872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM ROBERT HAUN SR. D.D.S.

Provider Business Mailing Address
First Line	:	4346 STARKEY RD STE 4
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-0605
Country	:	US
Telephone Number	:	540-774-7767
Fax Number	:	540-774-0945

Provider Business Practice Location Address
First Line	:	4346 STARKEY RD STE 4
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-0605
Country	:	US
Telephone Number	:	540-774-7767
Fax Number	:	540-774-0945

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/08/2007

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