Provider Demographics
NPI:1447393178
Name:HUFFMAN, DARYL (DMD)
Entity Type:Individual
Prefix:DR
First Name:DARYL
Middle Name:
Last Name:HUFFMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4610 OLEANDER DR
Mailing Address - Street 2:SUITE102
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5752
Mailing Address - Country:US
Mailing Address - Phone:843-449-7491
Mailing Address - Fax:843-449-8743
Practice Address - Street 1:4610 OLEANDER DR
Practice Address - Street 2:SUITE102
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5752
Practice Address - Country:US
Practice Address - Phone:843-449-7491
Practice Address - Fax:843-449-8743
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17501223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics