Provider Demographics
NPI:1710027180
Name:HAUGE, THOMAS PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:PAUL
Last Name:HAUGE
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 1:8755 136TH STREET CT N
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:MN
Mailing Address - Zip Code:55038-9130
Mailing Address - Country:US
Mailing Address - Phone:651-275-9094
Mailing Address - Fax:715-294-9995
Practice Address - Street 1:108 CHIEFTAIN ST
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:WI
Practice Address - Zip Code:54020-0159
Practice Address - Country:US
Practice Address - Phone:651-275-9094
Practice Address - Fax:715-294-9995
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI337600Medicaid