Provider Demographics
NPI:1679656987
Name:HUFFINES, RANDY FORD
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:FORD
Last Name:HUFFINES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 LONGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-3808
Mailing Address - Country:US
Mailing Address - Phone:423-979-3494
Mailing Address - Fax:
Practice Address - Street 1:JAMES H. QUILLEN/VAMC
Practice Address - Street 2:CORNER OF SIDNEY AND LAMONT
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-979-3494
Practice Address - Fax:423-979-3428
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000042421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice