Healthcare Provider Details

I. General information

NPI: 1962418079
Provider Name (Legal Business Name): KIMBERLY D. HAUG D.M.D.,M.S.,P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 MORNINGSTAR DR
ALTON IL
62002
US

IV. Provider business mailing address

2411 MORNINGSTAR DR
ALTON IL
62002
US

V. Phone/Fax

Practice location:
  • Phone: 618-463-7002
  • Fax: 618-463-7006
Mailing address:
  • Phone: 618-463-7002
  • Fax: 618-463-7006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: