Healthcare Provider Details

I. General information

NPI: 1376940296
Provider Name (Legal Business Name): KAITLIN HAAG DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2014
Last Update Date: 06/04/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2009 W J ST
MC COOK NE
69001-3090
US

IV. Provider business mailing address

2009 W J ST
MC COOK NE
69001-3090
US

V. Phone/Fax

Practice location:
  • Phone: 308-345-2273
  • Fax: 308-345-2750
Mailing address:
  • Phone: 308-345-2273
  • Fax: 308-345-2750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. KAITLIN HAAG
Title or Position: OWNER
Credential:
Phone: 308-350-2778