Healthcare Provider Details

I. General information

NPI: 1104903806
Provider Name (Legal Business Name): ANDREW DAVID HASS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 1ST ST E
CONOVER NC
28613-1718
US

IV. Provider business mailing address

404 1ST ST E
CONOVER NC
28613-1718
US

V. Phone/Fax

Practice location:
  • Phone: 828-464-5300
  • Fax: 828-464-1197
Mailing address:
  • Phone: 828-464-5300
  • Fax: 828-464-1197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6344
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: