Provider Demographics
NPI:1073595500
Name:HAAS, MARK FRANCIS (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:FRANCIS
Last Name:HAAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3727 DARROW RD
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-4011
Mailing Address - Country:US
Mailing Address - Phone:330-688-8667
Mailing Address - Fax:330-688-5280
Practice Address - Street 1:3727 DARROW RD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-4011
Practice Address - Country:US
Practice Address - Phone:330-688-8667
Practice Address - Fax:330-688-5280
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300179011223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0959600Medicaid