Provider Demographics
NPI:1275549230
Name:HAUGE, CARLA JONES (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:JONES
Last Name:HAUGE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 KELLOGG BLVD E
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-1237
Mailing Address - Country:US
Mailing Address - Phone:651-224-6234
Mailing Address - Fax:651-224-6581
Practice Address - Street 1:111 KELLOGG BLVD E
Practice Address - Street 2:SUITE 205
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-1237
Practice Address - Country:US
Practice Address - Phone:651-224-6234
Practice Address - Fax:651-224-6581
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN110511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice