Healthcare Provider Details

I. General information

NPI: 1629085741
Provider Name (Legal Business Name): JEFFREY S HUXFORD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 18TH ST SE
OWATONNA MN
55060-4005
US

IV. Provider business mailing address

520 FITZGERALD PL NE
OWATONNA MN
55060-1487
US

V. Phone/Fax

Practice location:
  • Phone: 507-451-2600
  • Fax: 507-444-0560
Mailing address:
  • Phone: 507-455-3755
  • Fax: 507-444-0560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10720
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: