Provider Demographics
NPI:1649375817
Name:HAERR, DIANA M (DDS)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:M
Last Name:HAERR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1758 MEADOWCREST DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15241-1316
Mailing Address - Country:US
Mailing Address - Phone:970-819-1806
Mailing Address - Fax:
Practice Address - Street 1:950 MANIFOLD RD STE 106
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-9602
Practice Address - Country:US
Practice Address - Phone:724-825-4602
Practice Address - Fax:724-909-0896
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0402821223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030745930009Medicaid
CO75533731Medicaid