Provider Demographics
NPI:1730263542
Name:HAACK, JOSEPH MEL (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MEL
Last Name:HAACK
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 1:1400 HAWTHORNE ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-4549
Mailing Address - Country:US
Mailing Address - Phone:320-763-7484
Mailing Address - Fax:320-763-6951
Practice Address - Street 1:1400 HAWTHORNE ST
Practice Address - Street 2:SUITE 4
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-4549
Practice Address - Country:US
Practice Address - Phone:320-763-7484
Practice Address - Fax:320-763-6951
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND10633122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist