Provider Demographics
NPI:1053359042
Name:HABERMAN, DANIEL (DDS)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:HABERMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 SECRET RIVER DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-3437
Mailing Address - Country:US
Mailing Address - Phone:916-428-1354
Mailing Address - Fax:
Practice Address - Street 1:905 SECRET RIVER DR
Practice Address - Street 2:SUITE D
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3437
Practice Address - Country:US
Practice Address - Phone:916-428-1354
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA470841223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics