Provider Demographics
NPI:1982857439
Name:HABAS, PHILIP VINCENT (DMD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:VINCENT
Last Name:HABAS
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 1:1209 HIGHLAND AVE STE L
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:KY
Mailing Address - Zip Code:41008-8820
Mailing Address - Country:US
Mailing Address - Phone:502-732-5506
Mailing Address - Fax:
Practice Address - Street 1:1209 HIGHLAND AVE STE L
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:KY
Practice Address - Zip Code:41008-8820
Practice Address - Country:US
Practice Address - Phone:502-732-5506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY56941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice