Provider Demographics
NPI:1992728018
Name:HAAKE, ROBERT ALLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALLEN
Last Name:HAAKE
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 1:3406 ROYAL MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95135-1641
Mailing Address - Country:US
Mailing Address - Phone:408-832-6995
Mailing Address - Fax:
Practice Address - Street 1:3406 ROYAL MEADOW LN
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95135-1641
Practice Address - Country:US
Practice Address - Phone:408-832-6995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33467122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7582450001Medicare NSC