Provider Demographics
NPI:1295878379
Name:HAAS, KENNETH H (DMD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:H
Last Name:HAAS
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 1:115 S WOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:63645-1348
Mailing Address - Country:US
Mailing Address - Phone:573-783-5573
Mailing Address - Fax:
Practice Address - Street 1:115 S WOOD AVE
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:MO
Practice Address - Zip Code:63645-1348
Practice Address - Country:US
Practice Address - Phone:573-783-5573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0137411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice