Doctor Name: | DR. JOHN A HADEN |
NPI Number: | 1104992122 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DMD |
License Number: | 010781 |
Business Practice Address: | 12166 Old Big Bend Ste 101 Kirkwood, MO - 63122 |
Business Phone Number: | 3148227123 |
Business Fax Number: | 3148227814 |
Mailing Address: | 12166 Old Big Bend, Ste 101 KIRKWOOD |
State: | MO |
Postal Code: | 63122 |
Phone Number: | 3148227123 |
Fax Number: | 3148227814 |
NPI Enumeration Date: | 11/28/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 204E00000X |
License Number: | 010781 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Oral & Maxillofacial Surgery |
Taxonomy Specialization: | |
Taxonomy Definition: |