Provider Demographics
NPI:1902020746
Name:HAUSAUER, HEIDI KATHRYN (DDS)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:KATHRYN
Last Name:HAUSAUER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5271 GLASS BROOK CT
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94552-5545
Mailing Address - Country:US
Mailing Address - Phone:510-581-1947
Mailing Address - Fax:
Practice Address - Street 1:3203 CASTRO VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5513
Practice Address - Country:US
Practice Address - Phone:510-538-3334
Practice Address - Fax:510-538-4116
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33774122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist