Provider Demographics
NPI:1447302369
Name:HASLAM, JOSHUA B (DMD)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:B
Last Name:HASLAM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1429 E HARMONY AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-5930
Mailing Address - Country:US
Mailing Address - Phone:480-586-8022
Mailing Address - Fax:480-855-7889
Practice Address - Street 1:1429 E HARMONY AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5930
Practice Address - Country:US
Practice Address - Phone:480-586-8022
Practice Address - Fax:480-855-7889
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD69911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice