Individual provider Active NPI

Joseph A Haake, DMD

  • Dentist
  • Louisville, KY
National Provider Identifier
1386747376
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
5960 Issued in KY
Practice address
University of Louisville School of Dentistry
501 S. Preston St.
Louisville, KY 40292-0001
Phone
(502) 852-5128
Fax
(502) 852-7163
NPI assigned
Sep 6, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 5960 KY Primary

Addresses

Primary practice location

University of Louisville School of Dentistry
501 S. Preston St.
Louisville, KY 40292-0001

Mailing address

University of Louisville School of Dentistry
501 S. Preston St.
Louisville, KY 40292-0001
Phone (502) 852-5128

Other identifiers 1

IdentifierTypeStateIssuer
60340593MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160121001172 KY Order and Referring Only - DentistPractitioner - Dentist 2365745536

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5960KYMDDentist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1386747376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "UNIVERSITY OF LOUISVILLE SCHOOL OF DENTISTRY",
            "address_2": "501 S. PRESTON ST.",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402920001",
            "telephone_number": "502-852-5128",
            "fax_number": "502-852-7163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "UNIVERSITY OF LOUISVILLE SCHOOL OF DENTISTRY",
            "address_2": "501 S. PRESTON ST.",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402920001",
            "telephone_number": "502-852-5128",
            "fax_number": "502-852-7163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAAKE",
        "first_name": "JOSEPH",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KY",
            "license": "5960",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60340593",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.