Healthcare Provider Details

I. General information

NPI: 1568964930
Provider Name (Legal Business Name): AUSTIN BRADFORD HUFF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 05/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GOODMAN ST
CINCINNATI OH
45219-2364
US

IV. Provider business mailing address

231 ALBERT SABIN WAY
CINCINNATI OH
45267-0769
US

V. Phone/Fax

Practice location:
  • Phone: 513-584-6660
  • Fax: 513-584-6661
Mailing address:
  • Phone: 513-584-6660
  • Fax: 513-584-6661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.025670
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: