Provider Demographics
NPI:1154490894
Name:THOMAS H HAUGEN DDS PA
Entity Type:Organization
Organization Name:THOMAS H HAUGEN DDS PA
Other - Org Name:ZUMBRO VIEW FAMILY DENTAL CARE ZUMBRO VIEW DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED DENTAL ASST/OFFICE ADMINIS
Authorized Official - Prefix:MS
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:RACHEL
Authorized Official - Last Name:SANNESS
Authorized Official - Suffix:
Authorized Official - Credentials:LDA/OFFICE ADMINISRA
Authorized Official - Phone:507-282-5309
Mailing Address - Street 1:132 ELTON HILLS LN NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-3567
Mailing Address - Country:US
Mailing Address - Phone:507-282-5309
Mailing Address - Fax:507-282-2761
Practice Address - Street 1:132 ELTON HILLS LN NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-3567
Practice Address - Country:US
Practice Address - Phone:507-282-5309
Practice Address - Fax:507-282-2761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMND107551223G0001X
MND115851223G0001X
MND114831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty