Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 15144 | ND |
N | 204E00000X | Oral & Maxillofacial Surgeon | DL-11263 | MA |
NPI | 1245526722 |
---|---|
Provider Name | Corbett A Haas |
First Address | Fargo, ND 58103-4940 |
Second Address | Fargo, ND 58103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2011 |
Last Update Date | 09/07/2018 |