Healthcare Provider Details

I. General information

NPI: 1033109723
Provider Name (Legal Business Name): TERRANCE LEO HAUCK M.D.,D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W CASCADE WAY SUITE 103
SPOKANE WA
99208-6003
US

IV. Provider business mailing address

5203 S HOGAN CT
SPOKANE WA
99223-8105
US

V. Phone/Fax

Practice location:
  • Phone: 509-468-1535
  • Fax: 509-467-6372
Mailing address:
  • Phone: 509-448-8790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number58645
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: