Provider Demographics
NPI:1043552193
Name:DR. KIMBERLY D. HAUG, PC
Entity type:Organization
Organization Name:DR. KIMBERLY D. HAUG, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAUG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS, PC
Authorized Official - Phone:618-654-8017
Mailing Address - Street 1:2411 MORNING STAR DR
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-5657
Mailing Address - Country:US
Mailing Address - Phone:618-463-7002
Mailing Address - Fax:618-463-7006
Practice Address - Street 1:5 CENTRAL BLVD
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IL
Practice Address - Zip Code:62249-1175
Practice Address - Country:US
Practice Address - Phone:618-654-8017
Practice Address - Fax:618-654-4124
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. KIMBERLY D. HAUG, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021.0019081223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty