MEDICARE: DR. ALEXANDRA HAASE D.D.S.

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	122300000X	Dentist	8784	SC

General Provider Information

NPI Number	:	1508319013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDRA HAASE D.D.S.

Provider Business Mailing Address
First Line	:	7398 RIVERS AVE.
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406
Country	:	US
Telephone Number	:	843-619-3537
Fax Number	:

Provider Business Practice Location Address
First Line	:	7398 RIVERS AVE
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-4613
Country	:	US
Telephone Number	:	843-619-3537
Fax Number	:

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

Provider Enumeration Date	:	08/01/2016
Last Update Date	:	11/16/2016

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