Healthcare Provider Details

I. General information

NPI: 1174576383
Provider Name (Legal Business Name): LEONORA HUFFSTUTTER DA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 BEAVER RUIN RD STE E
NORCROSS GA
30093
US

IV. Provider business mailing address

1480 BEAVER RUIN RD STE E
NORCROSS GA
30093
US

V. Phone/Fax

Practice location:
  • Phone: 770-449-0836
  • Fax: 770-717-0150
Mailing address:
  • Phone: 770-449-0836
  • Fax: 770-717-0150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: