Provider Demographics
NPI:1457484966
Name:HUNTINGTON DENTAL OFFICES, INC.
Entity Type:Organization
Organization Name:HUNTINGTON DENTAL OFFICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:K
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-423-5950
Mailing Address - Street 1:1211 HUNTINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-7934
Mailing Address - Country:US
Mailing Address - Phone:715-423-5950
Mailing Address - Fax:715-423-0693
Practice Address - Street 1:1211 HUNTINGTON AVE
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-7934
Practice Address - Country:US
Practice Address - Phone:715-423-5950
Practice Address - Fax:715-423-0693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty