Provider Demographics
NPI:1770075608
Name:HABERMAN, NORIKA JK (DMD)
Entity type:Individual
Prefix:
First Name:NORIKA
Middle Name:JK
Last Name:HABERMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 N HOWARD ST APT 126
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-2335
Mailing Address - Country:US
Mailing Address - Phone:909-576-5349
Mailing Address - Fax:
Practice Address - Street 1:1875 N CAMPUS AVE STE C
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91784-8211
Practice Address - Country:US
Practice Address - Phone:909-985-2302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX339531223G0001X
CA1065591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice