Healthcare Provider Details

I. General information

NPI: 1922250570
Provider Name (Legal Business Name): DOUGLAS GAIL HUFNAGEL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 10/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9434 DESCHUTES RD
PALO CEDRO CA
96073
US

IV. Provider business mailing address

P.O. BOX 537
PALO CEDRO CA
96073
US

V. Phone/Fax

Practice location:
  • Phone: 530-547-4418
  • Fax:
Mailing address:
  • Phone: 530-547-4418
  • Fax: 530-547-5333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number24462
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: