Individual
JACOB A HASLEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
167 N MAIN STREET, TUBA CITY, AZ 86045
(801) 318-7475
(866) 667-3006
Mailing address
PO BOX 600, TUBA CITY, AZ 86045
(801) 318-7475
(866) 667-3006
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7797
AZ
Other
Enumeration date
07/07/2009
Last updated
07/07/2009
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