Provider Demographics
NPI:1790700888
Name:HUFFMAN, JONATHAN C (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:C
Last Name:HUFFMAN
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 1:304 STATESVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2316
Mailing Address - Country:US
Mailing Address - Phone:704-637-0773
Mailing Address - Fax:704-637-0251
Practice Address - Street 1:304 STATESVILLE BLVD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2316
Practice Address - Country:US
Practice Address - Phone:704-637-0773
Practice Address - Fax:704-637-0251
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC74431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902E2Medicaid