Provider Demographics
NPI:1982752739
Name:HAFERNIK, MAURICE R JR (DDS)
Entity type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:R
Last Name:HAFERNIK
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:MAURY
Other - Middle Name:
Other - Last Name:HAFERNIK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:11645 ANGUS RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4100
Mailing Address - Country:US
Mailing Address - Phone:512-345-5552
Mailing Address - Fax:
Practice Address - Street 1:11645 ANGUS RD
Practice Address - Street 2:SUITE 10
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4100
Practice Address - Country:US
Practice Address - Phone:512-345-5552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11901122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist