Provider Demographics
NPI:1942286075
Name:HAAS, STEPHEN BECKLEY (DDS)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:BECKLEY
Last Name:HAAS
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 1:1 PINCKNEY BLVD
Mailing Address - Street 2:PO BOX 6216A
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-6148
Mailing Address - Country:US
Mailing Address - Phone:843-228-5577
Mailing Address - Fax:843-228-5196
Practice Address - Street 1:2005 KNIGHT LANE ATTN: MEDICAL STAFF SERVICES BLDG. H
Practice Address - Street 2:NAVY MEDICINE SUPPORT COMMAND
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32212-0140
Practice Address - Country:US
Practice Address - Phone:904-542-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV25261223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
000OTHMedicare UPIN