Provider Demographics
NPI:1750432191
Name:HAASE, JOSEPH A (DDS)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:HAASE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 LINWORTH RD E
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-2147
Mailing Address - Country:US
Mailing Address - Phone:614-885-2877
Mailing Address - Fax:614-436-7487
Practice Address - Street 1:4830 KNIGHTSBRIDGE BLVD
Practice Address - Street 2:SUITE L
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-2300
Practice Address - Country:US
Practice Address - Phone:614-459-2234
Practice Address - Fax:614-451-4388
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300136081223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics