MEDICARE: DR. RICHARD HABER DDS

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	1223G0001X	General Practice Dentistry	38004	CA

General Provider Information

NPI Number	:	1710002449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD HABER DDS

Provider Business Mailing Address
First Line	:	1260 15TH ST STE 701
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-1142
Country	:	US
Telephone Number	:	310-393-7766
Fax Number	:	310-394-8066

Provider Business Practice Location Address
First Line	:	1260 15TH ST STE 701
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-1142
Country	:	US
Telephone Number	:	310-393-7766
Fax Number	:	310-394-8066

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	12/20/2021

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