Provider Demographics
NPI:1679680870
Name:HAAS, EDWARD M (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:M
Last Name:HAAS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:PA
Mailing Address - Zip Code:17512-1224
Mailing Address - Country:US
Mailing Address - Phone:717-684-2401
Mailing Address - Fax:717-684-2402
Practice Address - Street 1:461 LOCUST ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:PA
Practice Address - Zip Code:17512-1224
Practice Address - Country:US
Practice Address - Phone:717-684-2401
Practice Address - Fax:717-684-2402
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025291L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010571420005Medicaid