Provider Demographics
NPI:1922250570
Name:HUFNAGEL, DOUGLAS GAIL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:GAIL
Last Name:HUFNAGEL
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:P.O. BOX 537
Mailing Address - Street 2:
Mailing Address - City:PALO CEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:96073
Mailing Address - Country:US
Mailing Address - Phone:530-547-4418
Mailing Address - Fax:530-547-5333
Practice Address - Street 1:9434 DESCHUTES RD
Practice Address - Street 2:
Practice Address - City:PALO CEDRO
Practice Address - State:CA
Practice Address - Zip Code:96073
Practice Address - Country:US
Practice Address - Phone:530-547-4418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24462122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist