| Jack W. Haney, D.d.s., P.c. | |
|
2315 Technology Dr Ste 101 O Fallon MO 63368-7371 | |
| (636) 561-9255 | |
| (636) 625-9028 |
| Full Name | Jack W. Haney, D.d.s., P.c. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2315 Technology Dr Ste 101, O Fallon, Missouri |
| Authorized Official Name and Position | Ty Justice (DIRECTOR, PAYER RELATIONS) |
| Authorized Official Contact | 5138084984 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jack W. Haney, D.d.s., P.c. 9825 Kenwood Rd Ste 200 Blue Ash OH 45242-6252 Ph: (513) 609-4076 | Jack W. Haney, D.d.s., P.c. 2315 Technology Dr Ste 101 O Fallon MO 63368-7371 Ph: (636) 561-9255 |
| NPI Number | 1285104661 |
|---|---|
| Provider Enumeration Date | 11/28/2018 |
| Last Update Date | 11/28/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285104661 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Secondary |
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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River City Endodontics Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 113 Church St, O Fallon, MO 63366 Phone: 636-362-4040 Fax: 636-362-4141 | |
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