Provider Demographics
NPI:1285765206
Name:HASCHKE, DOUGLAS (DDS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:HASCHKE
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 1:1715 WHEDBEE ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1046
Mailing Address - Country:US
Mailing Address - Phone:970-482-1015
Mailing Address - Fax:
Practice Address - Street 1:934 S LEMAY AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3207
Practice Address - Country:US
Practice Address - Phone:970-398-8300
Practice Address - Fax:970-498-8333
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO81121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice