Healthcare Provider Details

I. General information

NPI: 1487283404
Provider Name (Legal Business Name): CHARLES ALLEN HAUGE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 LANDMARK PL STE 100
MADISON WI
53713-4248
US

IV. Provider business mailing address

103 SUNSET CIR
COLUMBUS WI
53925-1873
US

V. Phone/Fax

Practice location:
  • Phone: 608-274-0770
  • Fax:
Mailing address:
  • Phone: 920-210-9719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number600143315
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: