Provider Demographics
NPI:1568552529
Name:HAKE, KAREN ANN (DMD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:HAKE
Suffix:
Gender:F
Credentials:DMD
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Other - First Name:
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Mailing Address - Street 1:8380 W CHEYENNE AVE
Mailing Address - Street 2:102
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-8405
Mailing Address - Country:US
Mailing Address - Phone:702-388-8989
Mailing Address - Fax:702-396-0075
Practice Address - Street 1:9330 LYNDON B JOHNSON FWY STE 1060
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3436
Practice Address - Country:US
Practice Address - Phone:214-757-4500
Practice Address - Fax:214-757-4501
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2020-08-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX229611223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX189125105Medicaid