Charity Keonna Haller, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DB-2024-0058 Issued in NY

Practice address

310 Continental Drive
Sutie 106
Jal, NM 88252-2525

Phone

(753) 952-2095

Fax

(575) 395-2205

NPI assigned

Sep 3, 2019

Sex

Female

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 24, 2024.

{
    "created_epoch": "1567468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719187200000",
    "number": "1699323576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 HITREE LN",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146244740",
            "telephone_number": "716-860-6822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 CONTINENTAL DRIVE",
            "address_2": "SUTIE 106",
            "city": "JAL",
            "state": "NM",
            "postal_code": "882522525",
            "telephone_number": "753-952-2095",
            "fax_number": "575-395-2205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALLER",
        "first_name": "CHARITY",
        "middle_name": "KEONNA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-09-03",
        "last_updated": "2024-06-24",
        "certification_date": "2022-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "DB-2024-0058",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• City of Jal General Fund
• Robyn Crawford
• Brandy Gooss, FNP
• James Gooss, FNP-BC
• Samantha Dawn Gooss, MSN, FNP-C
• Jami Hammons
• Beatrice Hauer, CNP
• Jal Hospital District
• Jal Hospital District
• Taylah Mata

• All providers in Jal, NM
• General Practice Dentistry in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2024; 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.