Healthcare Provider Details

I. General information

NPI: 1629012356
Provider Name (Legal Business Name): JEFFREY A HUYVAERT D.D.S. PC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 01/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 E. MICHIGAN STREET
NEW CARLISLE IN
46552
US

IV. Provider business mailing address

PO BOX 853
NEW CARLISLE IN
46552-0853
US

V. Phone/Fax

Practice location:
  • Phone: 574-654-8811
  • Fax: 574-654-8809
Mailing address:
  • Phone: 574-654-8811
  • Fax: 574-654-8809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12010051A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: