Provider Demographics
NPI:1124122536
Name:HAHN, RUDOLF GUSTAV (DMD)
Entity type:Individual
Prefix:DR
First Name:RUDOLF
Middle Name:GUSTAV
Last Name:HAHN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:COCOLALLA
Mailing Address - State:ID
Mailing Address - Zip Code:83813-0068
Mailing Address - Country:US
Mailing Address - Phone:208-699-6419
Mailing Address - Fax:
Practice Address - Street 1:616 E. MAIN STREET
Practice Address - Street 2:
Practice Address - City:CHEWELAH
Practice Address - State:WA
Practice Address - Zip Code:99109
Practice Address - Country:US
Practice Address - Phone:509-935-8642
Practice Address - Fax:509-935-4103
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA71641223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics