Individual
CORBETT A HAAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS,MD
Contact information
Practice address
3000 32ND AVE S, FARGO, ND 58103
(701) 364-8000
Mailing address
1702 UNIVERSITY DR S, FARGO, ND 58103-4940
(701) 364-4222
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
15144
ND
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
DL-11263
MA
Other
Enumeration date
06/23/2011
Last updated
07/09/2018
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