Healthcare Provider Details

I. General information

NPI: 1962662213
Provider Name (Legal Business Name): STEVEN KIRK HUFFAKER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 05/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GLEN ST SUITE 1B
GLENS FALLS NY
12801-4422
US

IV. Provider business mailing address

453 DIXON ROAD BLDG #3
QUEENSBURY NY
12804
US

V. Phone/Fax

Practice location:
  • Phone: 518-792-3636
  • Fax:
Mailing address:
  • Phone: 518-792-3636
  • Fax: 518-792-6847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number054364
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: