MEDICARE: DR. JOAN MARIE HAAS 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	32961	CA

General Provider Information

NPI Number	:	1770895203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOAN MARIE HAAS DDS

Provider Business Mailing Address
First Line	:	1360 N WINCHESTER BLVD
Second Line	:	SUITE 3
City	:	SAN JOSE
State	:	CA
Zip	:	95128-1150
Country	:	US
Telephone Number	:	408-248-2617
Fax Number	:	408-248-2618

Provider Business Practice Location Address
First Line	:	1360 N WINCHESTER BLVD
Second Line	:	SUITE 3
City	:	SAN JOSE
State	:	CA
Zip	:	95128-1150
Country	:	US
Telephone Number	:	408-248-2617
Fax Number	:	408-248-2618

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

Provider Enumeration Date	:	07/13/2010
Last Update Date	:	07/13/2010

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