Provider Demographics
NPI:1326064627
Name:HAERR, NATHAN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:A
Last Name:HAERR
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 1:1758 MEADOWCREST DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15241-1316
Mailing Address - Country:US
Mailing Address - Phone:970-846-8462
Mailing Address - Fax:412-771-5887
Practice Address - Street 1:1725 WASHINGTON RD STE 600
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15241-1207
Practice Address - Country:US
Practice Address - Phone:412-833-3944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040292122300000X
PADSO40292122300000X
CO84431223G0001X
NM22751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030058270001Medicaid
PA1030058270001Medicaid
CO75533731Medicaid