Provider Demographics
NPI:1073595500
Name:HAAS, MARK FRANCIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:FRANCIS
Last Name:HAAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 PORTAGE TRL
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-2104
Mailing Address - Country:US
Mailing Address - Phone:330-929-3077
Mailing Address - Fax:330-929-0963
Practice Address - Street 1:1234 PORTAGE TRL
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-2104
Practice Address - Country:US
Practice Address - Phone:330-929-3077
Practice Address - Fax:330-929-0963
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300179011223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0959600Medicaid