Provider Demographics
NPI:1669683728
Name:HUFFAKER, DAVID M (DDS)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:M
Last Name:HUFFAKER
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 1:134 SOUTH MAIN
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014
Mailing Address - Country:US
Mailing Address - Phone:801-292-5172
Mailing Address - Fax:801-295-5458
Practice Address - Street 1:134 SOUTH MAIN
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014
Practice Address - Country:US
Practice Address - Phone:801-292-5172
Practice Address - Fax:801-295-5458
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2009-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6219268122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT412209505OtherTIN