Provider Demographics
NPI:1467611921
Name:HUDDLESTON, DARREN S (DMD, PC)
Entity Type:Individual
Prefix:DR
First Name:DARREN
Middle Name:S
Last Name:HUDDLESTON
Suffix:
Gender:M
Credentials:DMD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 NE 6TH STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526
Mailing Address - Country:US
Mailing Address - Phone:541-476-8788
Mailing Address - Fax:541-471-0400
Practice Address - Street 1:1035 NE 6TH STREET
Practice Address - Street 2:SUITE A
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526
Practice Address - Country:US
Practice Address - Phone:541-476-8788
Practice Address - Fax:541-471-0400
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR77491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice