Provider Demographics
NPI:1457493066
Name:KONARD O. HAUFFE, DDS, PC
Entity Type:Organization
Organization Name:KONARD O. HAUFFE, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE CORPORATION OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KONARD
Authorized Official - Middle Name:O
Authorized Official - Last Name:HAUFFE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-692-4715
Mailing Address - Street 1:717 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-1426
Mailing Address - Country:US
Mailing Address - Phone:605-692-4715
Mailing Address - Fax:605-692-2427
Practice Address - Street 1:717 MAIN AVE
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-1426
Practice Address - Country:US
Practice Address - Phone:605-692-4715
Practice Address - Fax:605-692-2427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM7221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7806180Medicaid