Provider Demographics
NPI:1134274848
Name:JAMES D HAUGO DDS PA
Entity type:Organization
Organization Name:JAMES D HAUGO DDS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAUGO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:320-693-2228
Mailing Address - Street 1:715 N SIBLEY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LITCHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55355
Mailing Address - Country:US
Mailing Address - Phone:320-693-2228
Mailing Address - Fax:320-593-7655
Practice Address - Street 1:715 N SIBLEY
Practice Address - Street 2:SUITE 101
Practice Address - City:LITCHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55355
Practice Address - Country:US
Practice Address - Phone:320-693-2228
Practice Address - Fax:320-593-7655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN99951223G0001X
MN88471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty