Provider Demographics
NPI:1780749978
Name:HAAS, ANDREW J (ORTHODONTIST)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:J
Last Name:HAAS
Suffix:
Gender:M
Credentials:ORTHODONTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 WEATHERVANE LN
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-5102
Mailing Address - Country:US
Mailing Address - Phone:330-869-0137
Mailing Address - Fax:330-869-6386
Practice Address - Street 1:1208 WEATHERVANE LN
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-5102
Practice Address - Country:US
Practice Address - Phone:330-869-0137
Practice Address - Fax:330-869-6386
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300102251223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0959619Medicaid