Provider Demographics
NPI:1033240387
Name:PAUL A. HUDDLESTON, D.D.S., P.S.
Entity Type:Organization
Organization Name:PAUL A. HUDDLESTON, D.D.S., P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:HUDDLESTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-323-3830
Mailing Address - Street 1:1001 BROADWAY
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-4397
Mailing Address - Country:US
Mailing Address - Phone:206-323-3830
Mailing Address - Fax:206-322-0152
Practice Address - Street 1:1001 BROADWAY
Practice Address - Street 2:SUITE 209
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-4397
Practice Address - Country:US
Practice Address - Phone:206-323-3830
Practice Address - Fax:206-322-0152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA7924122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty