Provider Demographics
NPI:1053806554
Name:DE HAAN, KARLEE JEANE (DDS)
Entity type:Individual
Prefix:MS
First Name:KARLEE
Middle Name:JEANE
Last Name:DE HAAN
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 1:45 FLOCO AVE
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-5419
Mailing Address - Country:US
Mailing Address - Phone:904-875-4164
Mailing Address - Fax:904-875-6239
Practice Address - Street 1:45 FLOCO AVE
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-5419
Practice Address - Country:US
Practice Address - Phone:904-875-4164
Practice Address - Fax:904-875-6239
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34235122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist