Provider Demographics
NPI:1538271101
Name:HABAS, BRIAN JOSEPH (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JOSEPH
Last Name:HABAS
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:518 HILLGROVE AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558
Mailing Address - Country:US
Mailing Address - Phone:708-784-9930
Mailing Address - Fax:708-784-9931
Practice Address - Street 1:518 HILLGROVE AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558
Practice Address - Country:US
Practice Address - Phone:708-784-9930
Practice Address - Fax:708-784-9931
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012842122300000X
IL19-025633ENDODONTIST1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist