Provider Demographics
NPI:1558544544
Name:HEALTHWEST DENTAL ASSOCIATES PC
Entity Type:Organization
Organization Name:HEALTHWEST DENTAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:HUFHAM
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:334-702-1101
Mailing Address - Street 1:502 HEALTHWEST DRIVE
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303
Mailing Address - Country:US
Mailing Address - Phone:334-702-1101
Mailing Address - Fax:334-677-6176
Practice Address - Street 1:502 HEALTHWEST DRIVE
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303
Practice Address - Country:US
Practice Address - Phone:334-702-1101
Practice Address - Fax:334-677-6176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL45741223G0001X
AL47071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty