Provider Demographics
NPI:1912073719
Name:PHILIP V HABAS DMD PSC
Entity Type:Organization
Organization Name:PHILIP V HABAS DMD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:HABAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-732-5506
Mailing Address - Street 1:PO BOX 88
Mailing Address - Street 2:1209 HIGHLAND AVE SUITE L
Mailing Address - City:CARROLLTON
Mailing Address - State:KY
Mailing Address - Zip Code:41008
Mailing Address - Country:US
Mailing Address - Phone:502-732-5506
Mailing Address - Fax:
Practice Address - Street 1:1209 HIGHLAND AVE
Practice Address - Street 2:SUITE L
Practice Address - City:CARROLLTON
Practice Address - State:KY
Practice Address - Zip Code:41008
Practice Address - Country:US
Practice Address - Phone:502-732-5506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY56941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty