Provider Demographics
NPI:1992016034
Name:HAUGO, JILL MARIE
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:MARIE
Last Name:HAUGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:MARIE
Other - Last Name:BAUGNIET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15333 N PIMA RD
Mailing Address - Street 2:STE 103
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260
Mailing Address - Country:US
Mailing Address - Phone:602-298-1388
Mailing Address - Fax:602-298-1391
Practice Address - Street 1:15333 N PIMA RD
Practice Address - Street 2:STE 103
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260
Practice Address - Country:US
Practice Address - Phone:602-298-1388
Practice Address - Fax:602-298-1391
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126900000XDental ProvidersDental Laboratory Technician