Provider Demographics
NPI:1164474839
Name:HABERMAN, PATRICK MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:MICHAEL
Last Name:HABERMAN
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 1:1414 S OAK AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-3900
Mailing Address - Country:US
Mailing Address - Phone:507-451-2226
Mailing Address - Fax:507-455-9224
Practice Address - Street 1:1414 S OAK AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-3900
Practice Address - Country:US
Practice Address - Phone:507-451-2226
Practice Address - Fax:507-455-9224
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND111231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice