Provider Demographics
NPI:1962418079
Name:HAUG, KIMBERLY D (DMD,MS,PC)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:D
Last Name:HAUG
Suffix:
Gender:F
Credentials:DMD,MS,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 MORNINGSTAR DR
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002
Mailing Address - Country:US
Mailing Address - Phone:618-463-7002
Mailing Address - Fax:618-463-7006
Practice Address - Street 1:2411 MORNINGSTAR DR
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002
Practice Address - Country:US
Practice Address - Phone:618-463-7002
Practice Address - Fax:618-463-7006
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics