| Organization Name: | BRIAN R HABER DDS & JOSEPH A ILACQUA DDS PC |
| NPI Number: | 1093732000 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOSEPH ANTHONY ILACQUA (PRESIDENT OWNER) |
| Mailing Address: | 2603 Dekalb Pike Norristown |
| State: | PA US |
| Postal Code: | 19401 |
| Phone Number: | 6102750500 |
| Fax Number: | 6102751054 |
| NPI Enumeration Date: | 07/16/2006 |
| NPI Last Update Date: | 06/18/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 204E00000X |
| License Number: | DS019424L |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | PA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Oral & Maxillofacial Surgery |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |