MEDICARE: DR. HEIDI KATHRYN HAUSAUER 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	122300000X	Dentist	33774	CA

General Provider Information

NPI Number	:	1902020746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEIDI KATHRYN HAUSAUER D.D.S.

Provider Business Mailing Address
First Line	:	5271 GLASS BROOK CT
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94552-5545
Country	:	US
Telephone Number	:	510-581-1947
Fax Number	:

Provider Business Practice Location Address
First Line	:	3203 CASTRO VALLEY BLVD
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546-5513
Country	:	US
Telephone Number	:	510-538-3334
Fax Number	:	510-538-4116

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

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	07/08/2007

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