=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144427113
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GREGORY LEE HAUSER D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2007
-----------------------------------------------------
Last Update Date | 05/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1555 EL CAMINO REAL
-----------------------------------------------------
City | ARROYO GRANDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93420-2236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-481-3256
-----------------------------------------------------
Fax | 805-481-6249
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1290 ROSEVINE LN
-----------------------------------------------------
City | ARROYO GRANDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93420-5083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-440-8759
-----------------------------------------------------
Fax | 805-481-6249
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 26863
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------