Provider Demographics
NPI:1154070399
Name:HAUCK, KARISA (DA)
Entity Type:Individual
Prefix:
First Name:KARISA
Middle Name:
Last Name:HAUCK
Suffix:
Gender:F
Credentials:DA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 CERRITOS AVE STE B
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-4570
Mailing Address - Country:US
Mailing Address - Phone:714-723-6277
Mailing Address - Fax:
Practice Address - Street 1:5001 CERRITOS AVE STE B
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-4570
Practice Address - Country:US
Practice Address - Phone:714-723-6277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes126800000XDental ProvidersDental AssistantGroup - Single Specialty