MEDICARE: DR. JEFFREY K. HAUG D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	29789	CA

General Provider Information

NPI Number	:	1154429371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY K. HAUG D.D.S.

Provider Business Mailing Address
First Line	:	PO BOX 259
Second Line	:
City	:	DIABLO
State	:	CA
Zip	:	94528-0259
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5201 DEER VALLEY RD
Second Line	:	SUITE #3A
City	:	ANTIOCH
State	:	CA
Zip	:	94531-7429
Country	:	US
Telephone Number	:	925-757-6626
Fax Number	:	925-757-7240

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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