Healthcare Provider Details

I. General information

NPI: 1437159977
Provider Name (Legal Business Name): DAVID GREGORY HAAS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 W MARKET ST
FAIRLAWN OH
44333-2663
US

IV. Provider business mailing address

3500 W MARKET ST
FAIRLAWN OH
44333-2663
US

V. Phone/Fax

Practice location:
  • Phone: 330-666-6541
  • Fax: 330-666-5039
Mailing address:
  • Phone: 330-666-6541
  • Fax: 330-666-5039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number30-01-2470
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: