Healthcare Provider Details

I. General information

NPI: 1427527332
Provider Name (Legal Business Name): DANIEL LEVI HAUGHT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 W BASELINE RD STE 6
TEMPE AZ
85283-5371
US

IV. Provider business mailing address

825 W BASELINE RD STE 6
TEMPE AZ
85283-5371
US

V. Phone/Fax

Practice location:
  • Phone: 480-777-5570
  • Fax:
Mailing address:
  • Phone: 480-777-5570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: BENJAMIN E TUINEI
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 602-750-6897