Provider Demographics
NPI:1790793123
Name:HUITT, DOUGLAS C (DDS PA)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:C
Last Name:HUITT
Suffix:
Gender:M
Credentials:DDS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 N LAFAYETTE ST
Mailing Address - Street 2:STE 13
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150
Mailing Address - Country:US
Mailing Address - Phone:704-487-8931
Mailing Address - Fax:704-487-8332
Practice Address - Street 1:222 N LAFAYETTE ST
Practice Address - Street 2:STE 13
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150
Practice Address - Country:US
Practice Address - Phone:704-487-8931
Practice Address - Fax:704-487-8332
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5020122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7994230Medicaid
U37864Medicare UPIN