Provider Demographics
NPI:1811040363
Name:HAERENS, OLAF J (MPH, DDS)
Entity Type:Individual
Prefix:DR
First Name:OLAF
Middle Name:J
Last Name:HAERENS
Suffix:
Gender:M
Credentials:MPH, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 N HOUSTON AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-4122
Mailing Address - Country:US
Mailing Address - Phone:830-624-7300
Mailing Address - Fax:830-626-3100
Practice Address - Street 1:652 N HOUSTON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-4122
Practice Address - Country:US
Practice Address - Phone:830-624-7300
Practice Address - Fax:830-626-3100
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX183491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice