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General NPI Number Information
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NPI Number | 1679618938
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Entity Type | Organization
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Legal Business Name | J GREG HAAG DMD PSC
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 1250 THORNBERRY DR
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City | MADISONVILLE
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State | KY
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Zip | 42431
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Country | US
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Telephone | 270-825-9616
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Fax | 270-825-3901
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Provider Business Mailing Address
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Address Line | 1250 THORNBERRY DR
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City | MADISONVILLE
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State | KY
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Zip | 42431
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Country | US
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Telephone | 270-825-9616
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Fax | 270-825-3901
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES GREGORY HAAG
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Credential | DMD
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Telephone | 270-825-9616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6337
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License Number State | KY
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