Provider Demographics
NPI:1588842066
Name:HAASE-VERVAEKE, RENEE LOUISE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:LOUISE
Last Name:HAASE-VERVAEKE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9241 SILVER PINE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-9371
Mailing Address - Country:US
Mailing Address - Phone:248-486-1993
Mailing Address - Fax:
Practice Address - Street 1:G3222 BEECHER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3614
Practice Address - Country:US
Practice Address - Phone:517-882-7639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010148951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice