Provider Demographics
NPI:1356749568
Name:HAUGE, SANDRA (RDH)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:HAUGE
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 1:2 COPELAND AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54603-3400
Mailing Address - Country:US
Mailing Address - Phone:608-782-4054
Mailing Address - Fax:
Practice Address - Street 1:2 COPELAND AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54603-3400
Practice Address - Country:US
Practice Address - Phone:608-782-4054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5930-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist