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General NPI Number Information
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NPI Number | 1831104249
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Entity Type | Organization
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Legal Business Name | GALEN K. HAAS DDS PA
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1639 23RD AVE
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City | LEWISTON
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State | ID
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Zip | 83501-6308
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Country | US
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Telephone | 208-746-0431
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Fax | 208-746-2766
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Provider Business Mailing Address
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Address Line | 1639 23RD AVE
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City | LEWISTON
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State | ID
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Zip | 83501-6308
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Country | US
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Telephone | 208-746-0431
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Fax | 208-746-2766
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GALEN K HAAS
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Credential | DDS
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Telephone | 208-746-0431
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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 | D-1000
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License Number State | ID
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