=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902020746
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEIDI KATHRYN HAUSAUER D.D.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3203 CASTRO VALLEY BLVD
-----------------------------------------------------
City | CASTRO VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94546-5513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-538-3334
-----------------------------------------------------
Fax | 510-538-4116
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5271 GLASS BROOK CT
-----------------------------------------------------
City | CASTRO VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94552-5545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-581-1947
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 33774
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------