Provider Demographics
NPI:1255716270
Name:HAAKE, KRISTA (DDS)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:HAAKE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 EASTSIDE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310-3480
Mailing Address - Country:US
Mailing Address - Phone:402-223-4140
Mailing Address - Fax:402-228-1762
Practice Address - Street 1:110 EASTSIDE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-3480
Practice Address - Country:US
Practice Address - Phone:402-223-4140
Practice Address - Fax:402-228-1762
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7227122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist