Provider Demographics
NPI:1083090641
Name:HAASE, DANIELA
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:
Last Name:HAASE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16654 FALKIRK TRL
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-6142
Mailing Address - Country:US
Mailing Address - Phone:563-505-0360
Mailing Address - Fax:
Practice Address - Street 1:429 COMMERCE DR
Practice Address - Street 2:#400
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-6600
Practice Address - Country:US
Practice Address - Phone:651-731-2342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13606122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist