Jacob A Haslem, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

7797 Issued in AZ

Practice address

167 N Main Street
Tuba City, AZ 86045

Phone

(801) 318-7475

Fax

(866) 667-3006

NPI assigned

Jul 7, 2009

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

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Tuba City Regional Health Care Corporation

  • General Acute Care Hospital
  • Tuba City, AZ
  • NPI 1548294424

  TX

  Medicare reassignment NPD
• Tuba City Regional Health Care Corporation

  • Family Medicine Physician
  • Bodaway Gap, AZ
  • NPI 1710519913
  NPD

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

{
    "created_epoch": "1246924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1246924800000",
    "number": "1922237379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 600",
            "city": "TUBA CITY",
            "state": "AZ",
            "postal_code": "86045",
            "telephone_number": "801-318-7475",
            "fax_number": "866-667-3006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "167 N MAIN STREET",
            "city": "TUBA CITY",
            "state": "AZ",
            "postal_code": "86045",
            "telephone_number": "801-318-7475",
            "fax_number": "866-667-3006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HASLEM",
        "first_name": "JACOB",
        "middle_name": "A",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-07",
        "last_updated": "2009-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "7797",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vicki Lynn Harris, RN
• Regina Ann Conley Hart, DO
• Stephanie Hart, PHARMD
• Kimberly Ann Harvey, CERTIFIED NURSING AS
• Gwendolyn Mae Haskie
• Darcy Anna Hastings, R.N.
• Ann Hatathli, CBA
• Thomas Hatathli, MHT
• Valencia Ann Hatathli, RN
• Lenora Rose Hatathlie, HT

• Dentist in Tuba City, AZ
• Providers in Tuba City, AZ by specialty
• Dentist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.