Healthcare Provider Details

I. General information

NPI: 1417085994
Provider Name (Legal Business Name): ERIC F HUFFMAN DMD, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 N MAIN ST
NICHOLASVILLE KY
40356-1025
US

IV. Provider business mailing address

611 N MAIN ST
NICHOLASVILLE KY
40356-1025
US

V. Phone/Fax

Practice location:
  • Phone: 859-887-1110
  • Fax:
Mailing address:
  • Phone: 859-887-1110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number5839
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: