Jack W. Haney, D.d.s., P.c.

NPI #1285104661 in O Fallon, Missouri

Provider Information

NPI Number: 1285104661
Entity Type: Organization
Organization Name: Jack W. Haney, D.d.s., P.c.
Primary Specialty: Dentist - General Practice
Enumeration Date: Nov 28, 2018
Last Updated: Nov 28, 2018

Practice Location

Address: 2315 TECHNOLOGY DR STE 101
City: O Fallon
State: Missouri
ZIP Code: 63368-7371
Phone: (636) 561-9255

Authorized Official

Name: TY JUSTICE
Title: DIRECTOR, PAYER RELATIONS
Phone: (513) 808-4984

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X
Dentist - General Practice — General Practice	1223G0001X	Primary

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