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General NPI Number Information
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NPI Number | 1154490894
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Entity Type | Organization
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Legal Business Name | THOMAS H HAUGEN DDS PA
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 05/24/2011
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Provider Practice Location Address
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Address Line | 132 ELTON HILLS LN NW
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City | ROCHESTER
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State | MN
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Zip | 55901-3567
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Country | US
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Telephone | 507-282-5309
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Fax | 507-282-2761
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Provider Business Mailing Address
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Address Line | 132 ELTON HILLS LN NW
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City | ROCHESTER
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State | MN
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Zip | 55901-3567
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Country | US
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Telephone | 507-282-5309
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Fax | 507-282-2761
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Authorized Official
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Title or Position | LICENSED DENTAL ASST/OFFICE ADMINIS
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Name | MS. KERRY RACHEL SANNESS
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Credential | LDA/OFFICE ADMINISRA
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Telephone | 507-282-5309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | MND11585
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | MND11483
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | MND10755
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License Number State | MN
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