Provider Demographics
NPI:1336287788
Name:HAISCH, LARRY D (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:D
Last Name:HAISCH
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 1:9420 WILDFIRE RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-9391
Mailing Address - Country:US
Mailing Address - Phone:402-328-3421
Mailing Address - Fax:
Practice Address - Street 1:15TH AND U STREET
Practice Address - Street 2:UNIVERSITY HEALTH CENTER DENTAL OFFICE
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68588-0618
Practice Address - Country:US
Practice Address - Phone:402-472-7495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE38591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice