Provider Demographics
NPI:1699949529
Name:DAVID J. HAUSS, D.M.D., INC.
Entity type:Organization
Organization Name:DAVID J. HAUSS, D.M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JONATHAN
Authorized Official - Last Name:HAUSS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:562-435-8339
Mailing Address - Street 1:823 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-4512
Mailing Address - Country:US
Mailing Address - Phone:562-435-8339
Mailing Address - Fax:
Practice Address - Street 1:823 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-4512
Practice Address - Country:US
Practice Address - Phone:562-435-8339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA310761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB31076-01Medicaid