Provider Demographics
NPI:1780452052
Name:HEIDI K. HAUSAUER, D.D.S., INC.
Entity type:Organization
Organization Name:HEIDI K. HAUSAUER, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:HAUSAUER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-538-3334
Mailing Address - Street 1:3203 CASTRO VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5513
Mailing Address - Country:US
Mailing Address - Phone:510-538-3334
Mailing Address - Fax:510-538-4116
Practice Address - Street 1:3203 CASTRO VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5513
Practice Address - Country:US
Practice Address - Phone:510-538-3334
Practice Address - Fax:510-538-4116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental