Healthcare Provider Details

I. General information

NPI: 1598367237
Provider Name (Legal Business Name): SARA LYNN HUFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21190 COUNTY ROAD 151
WEST LAFAYETTE OH
43845-9739
US

IV. Provider business mailing address

21190 COUNTY ROAD 151
WEST LAFAYETTE OH
43845-9739
US

V. Phone/Fax

Practice location:
  • Phone: 810-650-8272
  • Fax:
Mailing address:
  • Phone: 810-650-8272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number23083
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number11652
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH.002024481
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: