Healthcare Provider Details

I. General information

NPI: 1174269955
Provider Name (Legal Business Name): ALEXANDER HAUG ARMY X2
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 05/05/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1363 ABERDEEN AVENUE
WHITE SANDS MISSILE RANGE NM
88002
US

IV. Provider business mailing address

2901 CASSIDY RD
FORT BLISS TX
79916-3502
US

V. Phone/Fax

Practice location:
  • Phone: 575-678-3597
  • Fax:
Mailing address:
  • Phone: 915-742-6001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: