Healthcare Provider Details

I. General information

NPI: 1700881752
Provider Name (Legal Business Name): KENNETH JOSEPH HUFF DDS.PS.,MAGD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CMR 454
APO AE
09250
US

IV. Provider business mailing address

CMR 454 PO BOX 1935
APO AE
09250
US

V. Phone/Fax

Practice location:
  • Phone: 253-350-2965
  • Fax:
Mailing address:
  • Phone: 253-350-2965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4580
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: