1992929202 NPI number — HAERR DENTISTRY P.C.

Table of content: (NPI 1992929202)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992929202 NPI number — HAERR DENTISTRY P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAERR DENTISTRY P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992929202
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 609
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAYDEN
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81639-0609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-276-3123
Provider Business Mailing Address Fax Number:
970-276-2500

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 WEST JACKSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAYDEN
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-276-3123
Provider Business Practice Location Address Fax Number:
970-276-2500
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HAERR
Authorized Official First Name:
NATHAN
Authorized Official Middle Name:
ADAM
Authorized Official Title or Position:
OWNER DENTIST
Authorized Official Telephone Number:
970-276-3123

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  8801 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 8443 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 67330258 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 75533731 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 94670846 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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