Provider Demographics
NPI:1114175940
Name:ROBERT E. HARADEN DDS, P.C.
Entity Type:Organization
Organization Name:ROBERT E. HARADEN DDS, P.C.
Other - Org Name:FAMILY DENTISTRY OF WOODSTOCK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:HARADEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-338-0690
Mailing Address - Street 1:142 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-3355
Mailing Address - Country:US
Mailing Address - Phone:815-338-0690
Mailing Address - Fax:815-338-4719
Practice Address - Street 1:142 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-3355
Practice Address - Country:US
Practice Address - Phone:815-338-0690
Practice Address - Fax:815-338-4719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty