Provider Demographics
NPI:1548803091
Name:THE DENTAL SQUAD, LLC
Entity Type:Organization
Organization Name:THE DENTAL SQUAD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:CYRUS
Authorized Official - Last Name:HAAG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:928-443-1200
Mailing Address - Street 1:172 E MERRITT ST STE F
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-2027
Mailing Address - Country:US
Mailing Address - Phone:928-443-1200
Mailing Address - Fax:928-445-0037
Practice Address - Street 1:172 E MERRITT ST STE F
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-2027
Practice Address - Country:US
Practice Address - Phone:928-443-1200
Practice Address - Fax:928-445-0037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental