Provider Demographics
NPI:1407209745
Name:PAUL M HUFFAKER, DMD, PLLC
Entity Type:Organization
Organization Name:PAUL M HUFFAKER, DMD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:HUFFAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:385-245-8247
Mailing Address - Street 1:134 S MAIN ST
Mailing Address - Street 2:SUITE #4
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-2814
Mailing Address - Country:US
Mailing Address - Phone:385-245-8247
Mailing Address - Fax:
Practice Address - Street 1:134 S MAIN ST
Practice Address - Street 2:SUITE #4
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014-2814
Practice Address - Country:US
Practice Address - Phone:385-245-8247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-22
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT98296579922261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental