Provider Demographics
NPI:1659659670
Name:HUFF, BENJAMIN KEITH (DMD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:KEITH
Last Name:HUFF
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-4623
Mailing Address - Country:US
Mailing Address - Phone:541-269-5353
Mailing Address - Fax:541-266-0933
Practice Address - Street 1:295 S 10TH ST
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-4623
Practice Address - Country:US
Practice Address - Phone:541-269-5353
Practice Address - Fax:541-266-0933
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD96041223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice