Healthcare Provider Details

I. General information

NPI: 1043450471
Provider Name (Legal Business Name): TIMOTHY JAYSON HUFF D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2009
Last Update Date: 02/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3157 S BOWN WAY
BOISE ID
83706-5400
US

IV. Provider business mailing address

3157 S BOWN WAY
BOISE ID
83706
US

V. Phone/Fax

Practice location:
  • Phone: 208-342-8000
  • Fax: 208-342-8011
Mailing address:
  • Phone: 208-342-8000
  • Fax: 208-342-8011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD 3700
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: