Provider Demographics
NPI:1922266923
Name:CROWE-HAUGSTAD, WENDY SUSAN (DDS)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:SUSAN
Last Name:CROWE-HAUGSTAD
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 1:6121 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-4506
Mailing Address - Country:US
Mailing Address - Phone:262-654-6535
Mailing Address - Fax:262-654-3358
Practice Address - Street 1:6121 7TH AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-4506
Practice Address - Country:US
Practice Address - Phone:262-654-6535
Practice Address - Fax:262-654-3358
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4692-015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist