Healthcare Provider Details

I. General information

NPI: 1295165090
Provider Name (Legal Business Name): JAMES B. HAAS, DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2013
Last Update Date: 11/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 MANCHESTER AVE
DERRY NH
03038-1931
US

IV. Provider business mailing address

4 MANCHESTER AVE
DERRY NH
03038-1931
US

V. Phone/Fax

Practice location:
  • Phone: 603-434-1586
  • Fax: 603-434-8025
Mailing address:
  • Phone: 603-434-1586
  • Fax: 603-434-8025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2662
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number03954
License Number StateNH

VIII. Authorized Official

Name: DR. JAMES BRADLEY HAAS
Title or Position: DOCTOR OF DENTAL SURGERY
Credential: DDS
Phone: 603-434-1586