Provider Demographics
NPI:1225229909
Name:HAUSY, KURT GABRIEL (DMD)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:GABRIEL
Last Name:HAUSY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 E. TRINIDAD AVE.
Mailing Address - Street 2:
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440
Mailing Address - Country:US
Mailing Address - Phone:863-983-6347
Mailing Address - Fax:863-983-7468
Practice Address - Street 1:316 E. TRINIDAD AVE.
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440
Practice Address - Country:US
Practice Address - Phone:863-983-6347
Practice Address - Fax:863-983-6347
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16742122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist