Provider Demographics
NPI:1740489186
Name:HA, CARMEN (DDS)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:
Last Name:HA
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 1:2050 S BROADWAY
Mailing Address - Street 2:STE E
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-8801
Mailing Address - Country:US
Mailing Address - Phone:805-925-3717
Mailing Address - Fax:
Practice Address - Street 1:2050 S BROADWAY
Practice Address - Street 2:STE E
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8801
Practice Address - Country:US
Practice Address - Phone:805-925-3717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA548211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice