# BRIAN R HABER DDS & JOSEPH A ILACQUA DDS PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093732000
- **Authorized official:** DR. JOSEPH ANTHONY ILACQUA DDS (PRESIDENT OWNER)
- **Authorized official phone:** (610) 275-0500

## Contact information

- **Practice address:** 2603 DEKALB PIKE, NORRISTOWN, PA 19401
- **Practice address phone:** (610) 275-0500
- **Practice address fax:** (610) 275-1054
- **Mailing address:** 2603 DEKALB PIKE, NORRISTOWN, PA 19401
- **Mailing address phone:** (610) 275-0500
- **Mailing address fax:** (610) 275-1054

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | DS019424L | PA | — |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | DS022706L | PA | Yes |

## Other

- **Enumeration date:** 07/16/2006
- **Last updated:** 06/18/2008