MEDICARE: DR. CLARENCE BRENT HAEBERLE 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	DNF000362	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912072174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLARENCE BRENT HAEBERLE DMD

Provider Business Mailing Address
First Line	:	1430 JOHN WESLEY GILBERT DR GC 4204
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30912-0004
Country	:	US
Telephone Number	:	706-721-2696
Fax Number	:	706-721-6778

Provider Business Practice Location Address
First Line	:	1430 JOHN WESLEY GILBERT DR
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30912-0004
Country	:	US
Telephone Number	:	706-721-2696
Fax Number	:	706-721-6778

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

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	02/19/2026

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