Provider Demographics
NPI:1881806842
Name:HUFFAKER, FORD B (DDS)
Entity type:Individual
Prefix:DR
First Name:FORD
Middle Name:B
Last Name:HUFFAKER
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 1:134 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:801-295-5458
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:801-295-5458
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1452431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice