Healthcare Provider Details

I. General information

NPI: 1205951357
Provider Name (Legal Business Name): RICHARD EDWARD HUFF D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 W DIXIE AVE
LEESBURG FL
34748-6310
US

IV. Provider business mailing address

1018 W DIXIE AVE
LEESBURG FL
34748-6310
US

V. Phone/Fax

Practice location:
  • Phone: 352-787-3310
  • Fax: 352-787-5927
Mailing address:
  • Phone: 352-787-3310
  • Fax: 352-787-5927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4813
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: