Provider Demographics
NPI:1710308572
Name:HAUBSTADT FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:HAUBSTADT FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:STECKLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-768-6925
Mailing Address - Street 1:306 E STATE ROUTE 68
Mailing Address - Street 2:
Mailing Address - City:HAUBSTADT
Mailing Address - State:IN
Mailing Address - Zip Code:47639-8200
Mailing Address - Country:US
Mailing Address - Phone:812-768-6925
Mailing Address - Fax:812-768-0095
Practice Address - Street 1:306 E STATE ROUTE 68
Practice Address - Street 2:
Practice Address - City:HAUBSTADT
Practice Address - State:IN
Practice Address - Zip Code:47639-8200
Practice Address - Country:US
Practice Address - Phone:812-768-6925
Practice Address - Fax:812-768-0095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty