Provider Demographics
NPI:1508148545
Name:JOHN W HUDDART DDS LLC
Entity Type:Organization
Organization Name:JOHN W HUDDART DDS LLC
Other - Org Name:LATHROP DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:HUDDART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-740-4294
Mailing Address - Street 1:611 OAK ST
Mailing Address - Street 2:P.O. BOX 79
Mailing Address - City:LATHROP
Mailing Address - State:MO
Mailing Address - Zip Code:64465-9737
Mailing Address - Country:US
Mailing Address - Phone:816-740-4294
Mailing Address - Fax:816-528-4295
Practice Address - Street 1:611 OAK ST
Practice Address - Street 2:
Practice Address - City:LATHROP
Practice Address - State:MO
Practice Address - Zip Code:64465-9737
Practice Address - Country:US
Practice Address - Phone:816-740-4294
Practice Address - Fax:816-528-4295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001014206261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental