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Organization

ALAN HAUSSERMANN

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ALAN W. HAUSSERMANN D.D.S. (GENERAL DENTISTRY)
(217) 359-2500
Entity
Organization

Contact information

Practice address
919 W KIRBY AVE, CHAMPAIGN, IL 61821-5121
(217) 359-0574
Mailing address
919 W KIRBY AVE, CHAMPAIGN, IL 61821-5121
(217) 359-0574

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1002155
IL
Enumeration date
03/11/2008
Last updated
03/11/2008
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