Provider Demographics
NPI:1710002449
Name:HABER, RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
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 1:1260 15TH ST STE 701
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1142
Mailing Address - Country:US
Mailing Address - Phone:310-393-7766
Mailing Address - Fax:310-394-8066
Practice Address - Street 1:1260 15TH ST STE 701
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1142
Practice Address - Country:US
Practice Address - Phone:310-393-7766
Practice Address - Fax:310-394-8066
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA380041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice