Healthcare Provider Details

I. General information

NPI: 1750432191
Provider Name (Legal Business Name): JOSEPH A HAASE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4830 KNIGHTSBRIDGE BLVD SUITE L
COLUMBUS OH
43214-2300
US

IV. Provider business mailing address

885 LINWORTH RD E
COLUMBUS OH
43235-2147
US

V. Phone/Fax

Practice location:
  • Phone: 614-459-2234
  • Fax: 614-451-4388
Mailing address:
  • Phone: 614-885-2877
  • Fax: 614-436-7487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number30013608
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: