Provider Demographics
NPI:1922501626
Name:BRAD HUFFAKER DDS PC
Entity Type:Organization
Organization Name:BRAD HUFFAKER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:FORD
Authorized Official - Last Name:HUFFAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-292-5172
Mailing Address - Street 1:134 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-2814
Mailing Address - Country:US
Mailing Address - Phone:801-292-5172
Mailing Address - Fax:
Practice Address - Street 1:134 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014-2814
Practice Address - Country:US
Practice Address - Phone:801-292-5172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10411720-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty