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General NPI Number Information
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NPI Number | 1053691121
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Entity Type | Organization
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Legal Business Name | JOHN HAUGEN DDS
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Dates
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Enumeration Date | 08/22/2011
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Last Update Date | 08/22/2011
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Provider Practice Location Address
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Address Line | 302 W 9TH ST
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City | MC COOK
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State | NE
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Zip | 69001-3517
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Country | US
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Telephone | 308-345-1449
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Fax |
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Provider Business Mailing Address
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Address Line | 302 W 9TH ST
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City | MC COOK
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State | NE
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Zip | 69001-3517
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Country | US
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Telephone | 308-345-1449
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Fax |
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Authorized Official
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Title or Position | RECEPTIONIST
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Name | TAMMY SOLOMON
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Credential |
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Telephone | 308-345-1449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 5999
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License Number State | NE
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