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NPI Code Detail

MEDICARE: PAMELA S HASS RDH

MEDICARE:   PAMELA S HASS  RDH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1124Q00000XDental Hygienist2902005004MI

General Provider Information

NPI Number : 1356446991
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAMELA S HASS RDH
Provider Business Mailing Address
First Line : 50 INDUSTRIAL PARK DRIVE
Second Line :
City : BANGOR
State : MI
Zip : 49013
Country : US
Telephone Number : 269-427-7937
Fax Number : 269-427-5180
Provider Business Practice Location Address
First Line : 697 WELD ST
Second Line :
City : BENTON HARBOR
State : MI
Zip : 49022-4843
Country : US
Telephone Number : 269-927-5300
Fax Number : 269-927-1956
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2006
Last Update Date : 07/08/2007

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Directions to “ PAMELA S HASS RDH” Practice Location

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