Provider Demographics
NPI:1497855902
Name:HUFF, KEVIN DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:DAVID
Last Name:HUFF
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 1:217 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-2905
Mailing Address - Country:US
Mailing Address - Phone:330-364-2011
Mailing Address - Fax:330-602-3001
Practice Address - Street 1:217 W 4TH ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-2905
Practice Address - Country:US
Practice Address - Phone:330-364-2011
Practice Address - Fax:330-602-3001
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH204881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH460989162OtherTAX IDENTIFICATION NUMBER