Provider Demographics
NPI:1366555898
Name:HAEGER, ROBERT SCOTT (DDS,MS,PS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SCOTT
Last Name:HAEGER
Suffix:
Gender:M
Credentials:DDS,MS,PS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24909 104TH AVE SE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-2819
Mailing Address - Country:US
Mailing Address - Phone:253-850-7043
Mailing Address - Fax:253-850-2073
Practice Address - Street 1:24909 104TH AVE SE
Practice Address - Street 2:SUITE 203
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-2819
Practice Address - Country:US
Practice Address - Phone:253-850-7043
Practice Address - Fax:253-850-2073
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000063631223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics