Healthcare Provider Details

I. General information

NPI: 1760476584
Provider Name (Legal Business Name): CONSTANCE ANN HUFF D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIR DAVID GRANT MEDICAL CENTER / 60TH DENTAL SQUADRON
TRAVIS AFB CA
94535-1809
US

IV. Provider business mailing address

6654 LEWIS RD
VACAVILLE CA
95687-9496
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-7001
  • Fax: 707-423-7117
Mailing address:
  • Phone: 707-816-8822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number5716
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: