Provider Demographics
NPI:1194713305
Name:HAEDGE, CARL III (DDS)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:
Last Name:HAEDGE
Suffix:III
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 1:19165 EAGLEVIEW LN
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-3801
Mailing Address - Country:US
Mailing Address - Phone:952-226-6312
Mailing Address - Fax:651-457-6682
Practice Address - Street 1:1525 LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:WEST SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-3411
Practice Address - Country:US
Practice Address - Phone:651-457-4888
Practice Address - Fax:651-457-6682
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND76771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice