Provider Demographics
NPI:1366972622
Name:MCCLENDON, HALEY BENNETT (DDS)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:BENNETT
Last Name:MCCLENDON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 S JOHN REDDITT DR
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-5483
Mailing Address - Country:US
Mailing Address - Phone:936-632-0077
Mailing Address - Fax:
Practice Address - Street 1:1703 TULANE DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-5607
Practice Address - Country:US
Practice Address - Phone:936-632-4477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX329231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice