Healthcare Provider Details

I. General information

NPI: 1487767711
Provider Name (Legal Business Name): THERESA HUH DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 11/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SILVER LN SUITE 222
EAST HARTFORD CT
06118-1296
US

IV. Provider business mailing address

800 SILVER LN SUITE 222
EAST HARTFORD CT
06118-1296
US

V. Phone/Fax

Practice location:
  • Phone: 860-263-7791
  • Fax: 860-216-0316
Mailing address:
  • Phone: 860-263-7791
  • Fax: 860-216-0316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number009843
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number009843
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: