Organization
JACK W. HANEY, D.D.S., P.C.
Active
Other names
Excellence In Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
TY JUSTICE (DIRECTOR, PAYER RELATIONS)
(513) 808-4984
Entity
Organization
Contact information
Practice address
1455 TRIAD CENTER DR STE A, SAINT PETERS, MO 63376-7359
(636) 928-5550
(636) 928-8433
Mailing address
9825 KENWOOD RD STE 200, BLUE ASH, OH 45242-6252
(513) 609-4076
(513) 448-0511
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
02/10/2020
Last updated
02/04/2021
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