Healthcare Provider Details

I. General information

NPI: 1073770970
Provider Name (Legal Business Name): JEFF C HUFFMAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3091 SULLIVANT AVE
COLUMBUS OH
43204-1831
US

IV. Provider business mailing address

3091 SULLIVANT AVE
COLUMBUS OH
43204-1831
US

V. Phone/Fax

Practice location:
  • Phone: 614-351-8235
  • Fax:
Mailing address:
  • Phone: 614-351-8235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number016269
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: