Provider Demographics
NPI:1457737538
Name:HAUGHT, CASEY (DMD)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:HAUGHT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 201ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:ND
Mailing Address - Zip Code:58521-9726
Mailing Address - Country:US
Mailing Address - Phone:701-426-7983
Mailing Address - Fax:
Practice Address - Street 1:3709 AUSTIN AVE
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-6626
Practice Address - Country:US
Practice Address - Phone:325-646-0516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31283122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist