Healthcare Provider Details

I. General information

NPI: 1710214812
Provider Name (Legal Business Name): THOMAS E HAUSER LD, DPD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2009
Last Update Date: 11/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1268 E MAIN ST SUITE 5
AUBURN WA
98002-5748
US

IV. Provider business mailing address

1268 E MAIN ST SUITE 5
AUBURN WA
98002-5748
US

V. Phone/Fax

Practice location:
  • Phone: 253-833-1834
  • Fax: 253-833-1841
Mailing address:
  • Phone: 253-833-1834
  • Fax: 253-833-1841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License NumberDN 60051783
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: