Provider Demographics
NPI:1932322245
Name:HUCKABEE & HUCKABEE DDS
Entity Type:Organization
Organization Name:HUCKABEE & HUCKABEE DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUCKABEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-350-1007
Mailing Address - Street 1:4701 LOGAN AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64136-1161
Mailing Address - Country:US
Mailing Address - Phone:816-350-1007
Mailing Address - Fax:816-350-1975
Practice Address - Street 1:4701 LOGAN AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64136-1161
Practice Address - Country:US
Practice Address - Phone:816-350-1007
Practice Address - Fax:816-350-1975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0157211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty