Healthcare Provider Details

I. General information

NPI: 1689983413
Provider Name (Legal Business Name): AMELIA HAFFNER BAUGH, DDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2010
Last Update Date: 09/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1373 AVONDALE HASLET RD.
HASLET TX
76052
US

IV. Provider business mailing address

1373 AVONDALE HASLET RD.
HASLET TX
76052
US

V. Phone/Fax

Practice location:
  • Phone: 817-296-1741
  • Fax:
Mailing address:
  • Phone: 817-296-1741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number24024
License Number StateTX

VIII. Authorized Official

Name: DR. AMELIA HAFFNER BAUGH
Title or Position: DENTIST/OWNER
Credential: D.D.S
Phone: 817-296-1741