Provider Demographics
NPI:1629525126
Name:HAUT, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:HAUT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 BRIGHT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-5150
Mailing Address - Country:US
Mailing Address - Phone:847-987-6681
Mailing Address - Fax:
Practice Address - Street 1:131 BRIGHT RIDGE DR
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194
Practice Address - Country:US
Practice Address - Phone:847-987-6681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL020010757124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist