MEDICARE: DR. JONATHAN LEE HAUN DMD

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
1	1223P0700X	Prosthodontics	D6592	OR

General Provider Information

NPI Number	:	1386638096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN LEE HAUN DMD

Provider Business Mailing Address
First Line	:	238 WILSON ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21217-4313
Country	:	US
Telephone Number	:	571-330-6350
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 M ST SE
Second Line	:	BLDG #166, BRANCH DENTAL CLINIC, WNY
City	:	WASHINGTON
State	:	DC
Zip	:	20374-0001
Country	:	US
Telephone Number	:	202-433-2480
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	07/08/2007

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