Provider Demographics
NPI:1588958169
Name:HAUPTMAN, ROBERT J (DMD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:HAUPTMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 HIGHWAY 51 STE G
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-5020
Mailing Address - Country:US
Mailing Address - Phone:601-790-9245
Mailing Address - Fax:601-790-9236
Practice Address - Street 1:1716 HIGHWAY 51 STE G
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-5020
Practice Address - Country:US
Practice Address - Phone:601-790-9245
Practice Address - Fax:601-790-9236
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3581-11122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist