Provider Demographics
NPI:1366659195
Name:HAUFF, THOMAS GODBERG (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GODBERG
Last Name:HAUFF
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 1:1227 PINE ST
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-2951
Mailing Address - Country:US
Mailing Address - Phone:847-998-6177
Mailing Address - Fax:
Practice Address - Street 1:1545 WAUKEGAN RD
Practice Address - Street 2:
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:847-729-0415
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19123851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice