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General NPI Number Information
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NPI Number | 1518946755
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Entity Type | Individual
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Provider Name | ROBERT CHARLES HAACK DDS
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Gender | Male
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Dates
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Enumeration Date | 01/16/2006
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Last Update Date | 08/23/2016
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Provider Practice Location Address
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Address Line | 6809 CASCADE RD SE STE F SUITE E
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-6895
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Country | US
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Telephone | 616-942-9040
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Fax | 616-837-9705
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Provider Business Mailing Address
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Address Line | 6809 CASCADE RD SE STE F SUITE E
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-6895
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Country | US
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Telephone | 616-942-9040
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Fax | 616-837-9705
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901010428
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License Number State | MI
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