Provider Demographics
NPI:1194801548
Name:HAUPT, THOMAS JEFFERSON (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JEFFERSON
Last Name:HAUPT
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 1:33116 PALMER RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-5524
Mailing Address - Country:US
Mailing Address - Phone:734-728-2616
Mailing Address - Fax:
Practice Address - Street 1:33116 PALMER RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-5524
Practice Address - Country:US
Practice Address - Phone:734-728-2616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI94171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI124030296Medicaid