Provider Demographics
NPI:1558040659
Name:HA, NAM (DDS)
Entity Type:Individual
Prefix:
First Name:NAM
Middle Name:
Last Name:HA
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 1:4800 HOLDREGE ST APT 410
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504-3176
Mailing Address - Country:US
Mailing Address - Phone:571-226-0738
Mailing Address - Fax:
Practice Address - Street 1:4000 E CAMPUS LOOP S
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68583-1530
Practice Address - Country:US
Practice Address - Phone:402-472-1302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401418494122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No122300000XDental ProvidersDentist