Provider Demographics
NPI:1669493441
Name:HABER, BRIAN R (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:R
Last Name:HABER
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 1:660 VALLEY FORGE RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460
Mailing Address - Country:US
Mailing Address - Phone:610-935-0840
Mailing Address - Fax:610-935-2025
Practice Address - Street 1:660 VALLEY FORGE RD
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460
Practice Address - Country:US
Practice Address - Phone:610-935-0840
Practice Address - Fax:610-935-2025
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019424L204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T71933Medicare UPIN
085724Medicare ID - Type Unspecified