Provider Demographics
NPI:1699889733
Name:HAUSER, WALTER DAN (DDS)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:DAN
Last Name:HAUSER
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:W. DAN HAUSER
Mailing Address - Street 2:4603 SKYWAY ST., SUITE 101
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605
Mailing Address - Country:US
Mailing Address - Phone:208-454-3114
Mailing Address - Fax:208-454-3173
Practice Address - Street 1:4603 SKYWAY ST., SUITE 101
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605
Practice Address - Country:US
Practice Address - Phone:208-454-3114
Practice Address - Fax:208-454-3173
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-32611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805741000Medicaid