Provider Demographics
NPI:1699821470
Name:PAUL A. HAUGE, DDS, LTD
Entity Type:Organization
Organization Name:PAUL A. HAUGE, DDS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:HAUGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-646-2161
Mailing Address - Street 1:601 6TH ST HWY 35
Mailing Address - Street 2:P O BOX 459
Mailing Address - City:CENTURIA
Mailing Address - State:WI
Mailing Address - Zip Code:54824-0459
Mailing Address - Country:US
Mailing Address - Phone:715-646-2161
Mailing Address - Fax:715-646-2023
Practice Address - Street 1:601 6TH ST HWY 35
Practice Address - Street 2:
Practice Address - City:CENTURIA
Practice Address - State:WI
Practice Address - Zip Code:54824-0459
Practice Address - Country:US
Practice Address - Phone:715-646-2161
Practice Address - Fax:715-646-2023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50014081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38390000Medicaid