MEDICARE: CODY W HASLAM 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	2110	MT

General Provider Information

NPI Number	:	1861539066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CODY W HASLAM DDS

Provider Business Mailing Address
First Line	:	3475 COOK AVENUE
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59102
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3307 GRAND AVE
Second Line	:	SUITE 105
City	:	BILLINGS
State	:	MT
Zip	:	59102-6546
Country	:	US
Telephone Number	:	406-652-7313
Fax Number	:

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	07/08/2007

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