Provider Demographics
NPI:1154429371
Name:HAUG, JEFFREY K (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:K
Last Name:HAUG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 259
Mailing Address - Street 2:
Mailing Address - City:DIABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94528-0259
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5201 DEER VALLEY RD
Practice Address - Street 2:SUITE #3A
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-7429
Practice Address - Country:US
Practice Address - Phone:925-757-6626
Practice Address - Fax:925-757-7240
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA297891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice