Healthcare Provider Details

I. General information

NPI: 1417796301
Provider Name (Legal Business Name): VAKHTANG HUHUA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 05/21/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1790 E BRIDGE ST
BRIGHTON CO
80601-1934
US

IV. Provider business mailing address

1880 ARAPAHOE ST APT 2004
DENVER CO
80202-1856
US

V. Phone/Fax

Practice location:
  • Phone: 303-659-1064
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN.00205969
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: