Provider Demographics
NPI:1073663449
Name:PUFFER, DUNCAN R (DDS)
Entity Type:Individual
Prefix:
First Name:DUNCAN
Middle Name:R
Last Name:PUFFER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3617 W ARROWHEAD RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-4046
Mailing Address - Country:US
Mailing Address - Phone:218-722-8377
Mailing Address - Fax:218-722-3117
Practice Address - Street 1:3617 W ARROWHEAD RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-4046
Practice Address - Country:US
Practice Address - Phone:218-722-8377
Practice Address - Fax:218-722-3117
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND104801223S0112X
WI45871223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33720200OtherWISCONSIN MEDICAID
MN6B745PUOtherMINNESOTA BCBS
MN143022000Medicaid
MN199000539Medicare PIN
WI33720200OtherWISCONSIN MEDICAID
MN6B745PUOtherMINNESOTA BCBS
WI0002Medicare PIN