Provider Demographics
NPI:1336215136
Name:HAUSTEIN, VALERIE ANN (RDH)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:ANN
Last Name:HAUSTEIN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15172 W 62ND WAY
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80403-7412
Mailing Address - Country:US
Mailing Address - Phone:303-827-5687
Mailing Address - Fax:
Practice Address - Street 1:15172 W 62ND WAY
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80403-7412
Practice Address - Country:US
Practice Address - Phone:303-827-5687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO903718124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO76286711Medicaid