Robert E Hackley Jr., DDS

Primary specialty

DentistTaxonomy code 122300000X

License

12109 Issued in MN

Practice address

306 4TH St N
Fargo, ND 58102-4820

Phone

(701) 239-7111

NPI assigned

Nov 21, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Spirit Lake Health Center

  • Health Service Clinic/Center
  • Fort Totten, ND
  • NPI 1073665493
  NPD (past)
• Spirit Lake Tribe

  dba Spirit Lake Health Center

  • Health Service Clinic/Center
  • Fort Totten, ND
  • NPI 1114472891
  NPD (past)
• University of North Dakota

  • Clinic/Center
  • Grand Forks, ND
  • NPI 1952969099
  NPD (past)
• Fallon Tribal Health Center

  • Clinic/Center
  • Fallon, NV
  • NPI 1023057478
  NPD (past)
• Family Health Care Center

  dba Family HealthCare

  • Federally Qualified Health Center (FQHC)
  • Moorhead, MN
  • NPI 1992559645
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1407921919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2625",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581082625",
            "telephone_number": "701-239-7111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 4TH ST N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581024820",
            "telephone_number": "701-239-7111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HACKLEY",
        "first_name": "ROBERT",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "12109",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41358",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heather Marie Haarstad, LPN
• Alexandria Beth Haas
• Corbett A Haas, DDS,MD
• Mary Omer Habib, APRN, CNP
• Sheikh Habibullah, MD
• Kelly M Hadland-Betker, ATC
• Alison Haecherl, MSN, RN
• Johanna Haerter, RBT
• Sheila Jean Hagel
• Melanie Lynn Hageman, DDS

• Dentist in Fargo, ND
• Providers in Fargo, ND by specialty
• Dentist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.