Provider Demographics
NPI:1962662213
Name:HUFFAKER, STEVEN KIRK (DMD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:KIRK
Last Name:HUFFAKER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GLEN ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4422
Mailing Address - Country:US
Mailing Address - Phone:518-792-3636
Mailing Address - Fax:
Practice Address - Street 1:100 GLEN ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4422
Practice Address - Country:US
Practice Address - Phone:518-792-3636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2009-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0543641223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics