Provider Demographics
NPI:1093957946
Name:HAAG, LOUIS RICHARD (DDS)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:RICHARD
Last Name:HAAG
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 1:1815 THISTLE RD
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-7790
Mailing Address - Country:US
Mailing Address - Phone:928-526-0616
Mailing Address - Fax:928-526-1443
Practice Address - Street 1:1815 N. THISTLE RD.
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004
Practice Address - Country:US
Practice Address - Phone:928-526-0616
Practice Address - Fax:928-526-1443
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2039122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist