# HAAKE FAMILY DENTAL LLC

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

## Provider details

- **NPI number:** 1275703811
- **Authorized official:** DR. STEPHEN M HAAKE DDS (DENTIST)
- **Authorized official phone:** (913) 381-6644

## Contact information

- **Practice address:** 4601 W 109TH ST, SUITE 112, OVERLAND PARK, KS 66211-1318
- **Practice address phone:** (913) 381-6644
- **Practice address fax:** (913) 381-6646
- **Mailing address:** 4601 W 109TH ST, SUITE 112, OVERLAND PARK, KS 66211-1318
- **Mailing address phone:** (913) 381-6644
- **Mailing address fax:** (913) 381-6646

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | 60089 | KS | Yes |

## Other

- **Enumeration date:** 03/11/2008
- **Last updated:** 06/25/2013