Healthcare Provider Details

I. General information

NPI: 1457493066
Provider Name (Legal Business Name): KONARD O. HAUFFE, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 MAIN AVE
BROOKINGS SD
57006-1426
US

IV. Provider business mailing address

717 MAIN AVE
BROOKINGS SD
57006-1426
US

V. Phone/Fax

Practice location:
  • Phone: 605-692-4715
  • Fax: 605-692-2427
Mailing address:
  • Phone: 605-692-4715
  • Fax: 605-692-2427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberM722
License Number StateSD

VIII. Authorized Official

Name: KONARD O HAUFFE
Title or Position: SOLE CORPORATION OWNER
Credential: D.D.S.
Phone: 605-692-4715