Provider Demographics
NPI:1750615258
Name:JEFFREY HUYVAERT DDS PC
Entity type:Organization
Organization Name:JEFFREY HUYVAERT DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUYVAERT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PC
Authorized Official - Phone:574-654-8811
Mailing Address - Street 1:PO BOX 853
Mailing Address - Street 2:132 E MICHIGAN ST
Mailing Address - City:NEW CARLISLE
Mailing Address - State:IN
Mailing Address - Zip Code:46552-0853
Mailing Address - Country:US
Mailing Address - Phone:574-654-8811
Mailing Address - Fax:
Practice Address - Street 1:132 E MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:NEW CARLISLE
Practice Address - State:IN
Practice Address - Zip Code:46552
Practice Address - Country:US
Practice Address - Phone:574-654-8811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-30
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010051A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty