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NPI Code Detail

MEDICARE: DR. DAVID C HADERLIE DDS

MEDICARE: DR. DAVID C HADERLIE 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
1122300000XDentistD4237ID
2122300000XDentistDE60720894WA
31223E0200XEndodontics60720894WA
41223E0200XEndodonticsDE60720894WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1528296399
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID C HADERLIE DDS
Provider Business Mailing Address
First Line : 263 FARMINGTON AVE
Second Line :
City : FARMINGTON
State : CT
Zip : 06030-0002
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 605 S COOLIDGE ST
Second Line :
City : MOSES LAKE
State : WA
Zip : 98837-1873
Country : US
Telephone Number : 509-765-0674
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2009
Last Update Date : 08/04/2022

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