Organization
LIVE OAK PEDIATRIC DENTISTRY
Active
Other names
Olympia Hills Junior Pediatric Dental
Organization subpart
No
Provider details
NPI number
Authorized official
JERAME HAFEN DDS (OWNER)
(210) 845-8831
Entity
Organization
Contact information
Practice address
8056 SHIN OAK DR STE 200, LIVE OAK, TX 78233-2957
(210) 441-3360
(210) 441-3387
Mailing address
8056 SHIN OAK DR STE 200, LIVE OAK, TX 78233-2957
(210) 441-3360
(210) 441-3387
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
01/10/2023
Last updated
01/27/2025
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