Provider Demographics
NPI:1497182091
Name:HAUGHEY, MARIANA DEDEUS (DDS)
Entity Type:Individual
Prefix:
First Name:MARIANA
Middle Name:DEDEUS
Last Name:HAUGHEY
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 1:5 HAWTHORNE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01073-9473
Mailing Address - Country:US
Mailing Address - Phone:406-839-3413
Mailing Address - Fax:406-839-3413
Practice Address - Street 1:5 HAWTHORNE DR
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01073-9473
Practice Address - Country:US
Practice Address - Phone:406-839-3413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010205531223X0400X
MADN18569581223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics