Provider Demographics
NPI:1831104249
Name:GALEN K. HAAS DDS PA
Entity Type:Organization
Organization Name:GALEN K. HAAS DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GALEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:HAAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-746-0431
Mailing Address - Street 1:1639 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-6308
Mailing Address - Country:US
Mailing Address - Phone:208-746-0431
Mailing Address - Fax:208-746-2766
Practice Address - Street 1:1639 23RD AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-6308
Practice Address - Country:US
Practice Address - Phone:208-746-0431
Practice Address - Fax:208-746-2766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-1000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty