Provider Demographics
NPI:1265650832
Name:HAUFF, JR., THOMAS GODBERG (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GODBERG
Last Name:HAUFF, JR.
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 1:1243 SANDPIPER CT
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-3209
Mailing Address - Country:US
Mailing Address - Phone:847-548-5830
Mailing Address - Fax:
Practice Address - Street 1:1545 WAUKEGAN RD
Practice Address - Street 2:SUITE 9
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-2166
Practice Address - Country:US
Practice Address - Phone:847-729-1747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19211971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice