Provider Demographics
NPI:1992929202
Name:HAERR DENTISTRY P.C.
Entity type:Organization
Organization Name:HAERR DENTISTRY P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:HAERR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-276-3123
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:CO
Mailing Address - Zip Code:81639-0609
Mailing Address - Country:US
Mailing Address - Phone:970-276-3123
Mailing Address - Fax:970-276-2500
Practice Address - Street 1:150 WEST JACKSON ST
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:CO
Practice Address - Zip Code:81639
Practice Address - Country:US
Practice Address - Phone:970-276-3123
Practice Address - Fax:970-276-2500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO84431223G0001X
CO88011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO67330258Medicaid
CO75533731Medicaid
CO94670846Medicaid