1154490894 NPI number — THOMAS H HAUGEN DDS PA

Table of content: (NPI 1154490894)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154490894 NPI number — THOMAS H HAUGEN DDS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS H HAUGEN DDS PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ZUMBRO VIEW FAMILY DENTAL CARE ZUMBRO VIEW DENTAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154490894
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
132 ELTON HILLS LN NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55901-3567
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-282-5309
Provider Business Mailing Address Fax Number:
507-282-2761

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
132 ELTON HILLS LN NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55901-3567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-282-5309
Provider Business Practice Location Address Fax Number:
507-282-2761
Provider Enumeration Date:
11/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SANNESS
Authorized Official First Name:
KERRY
Authorized Official Middle Name:
RACHEL
Authorized Official Title or Position:
LICENSED DENTAL ASST/OFFICE ADMINIS
Authorized Official Telephone Number:
507-282-5309

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  MND10755 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: MND11585 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: MND11483 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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