Provider Demographics
NPI:1770895203
Name:HAAS, JOAN MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:MARIE
Last Name:HAAS
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 1:1360 N WINCHESTER BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1150
Mailing Address - Country:US
Mailing Address - Phone:408-248-2617
Mailing Address - Fax:408-248-2618
Practice Address - Street 1:1360 N WINCHESTER BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1150
Practice Address - Country:US
Practice Address - Phone:408-248-2617
Practice Address - Fax:408-248-2618
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA329611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice