Provider Demographics
NPI:1235578519
Name:HAUGEN, MIKKEL DEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MIKKEL
Middle Name:DEAN
Last Name:HAUGEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 SUNRISE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ST PETER
Mailing Address - State:MN
Mailing Address - Zip Code:56082
Mailing Address - Country:US
Mailing Address - Phone:507-931-1230
Mailing Address - Fax:507-931-1493
Practice Address - Street 1:402 SUNRISE DRIVE
Practice Address - Street 2:
Practice Address - City:ST PETER
Practice Address - State:MN
Practice Address - Zip Code:56082
Practice Address - Country:US
Practice Address - Phone:507-931-1230
Practice Address - Fax:507-931-1493
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13232122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist