Provider Demographics
NPI:1629012356
Name:HUYVAERT, JEFFREY A (DDS PC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:HUYVAERT
Suffix:
Gender:M
Credentials:DDS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 853
Mailing Address - Street 2:
Mailing Address - City:NEW CARLISLE
Mailing Address - State:IN
Mailing Address - Zip Code:46552-0853
Mailing Address - Country:US
Mailing Address - Phone:574-654-8811
Mailing Address - Fax:574-654-8809
Practice Address - Street 1:132 E. MICHIGAN STREET
Practice Address - Street 2:
Practice Address - City:NEW CARLISLE
Practice Address - State:IN
Practice Address - Zip Code:46552
Practice Address - Country:US
Practice Address - Phone:574-654-8811
Practice Address - Fax:574-654-8809
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010051A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200295850AMedicaid