=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649375817
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DIANA M HAERR DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2006
-----------------------------------------------------
Last Update Date | 01/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 950 MANIFOLD RD STE 106
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15301-9602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-825-4602
-----------------------------------------------------
Fax | 724-909-0896
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1758 MEADOWCREST DR
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15241-1316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-819-1806
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | DS040282
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------