Provider Demographics
NPI:1356496244
Name:HOLDEN DENTAL CENTER, P.A.
Entity Type:Organization
Organization Name:HOLDEN DENTAL CENTER, P.A.
Other - Org Name:JOHN T. HAUGE, D.M.D.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:HAUGE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-990-2727
Mailing Address - Street 1:498 ESSEX ST
Mailing Address - Street 2:#103
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3990
Mailing Address - Country:US
Mailing Address - Phone:207-990-2727
Mailing Address - Fax:207-990-2729
Practice Address - Street 1:498 ESSEX ST
Practice Address - Street 2:#103
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3990
Practice Address - Country:US
Practice Address - Phone:207-990-2727
Practice Address - Fax:207-990-2729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3319261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental