Provider Demographics
NPI:1659470268
Name:HAUCK, DANIEL EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:EUGENE
Last Name:HAUCK
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 1:1224 E JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-3841
Mailing Address - Country:US
Mailing Address - Phone:307-856-3463
Mailing Address - Fax:307-856-9910
Practice Address - Street 1:1224 E JACKSON AVE
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-3841
Practice Address - Country:US
Practice Address - Phone:307-856-3463
Practice Address - Fax:307-856-9910
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY10941223G0001X
WY14341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
312209OtherBCBS
WY118488100Medicaid