Provider Demographics
NPI:1316016256
Name:HUPPERT, TED LOUIS (DDS)
Entity Type:Individual
Prefix:
First Name:TED
Middle Name:LOUIS
Last Name:HUPPERT
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 1:2424 STRINGTOWN RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47711-3361
Mailing Address - Country:US
Mailing Address - Phone:812-424-2400
Mailing Address - Fax:812-424-8377
Practice Address - Street 1:2424 STRINGTOWN RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47711-3361
Practice Address - Country:US
Practice Address - Phone:812-424-2400
Practice Address - Fax:812-424-8377
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007611A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100133250Medicaid