Healthcare Provider Details

I. General information

NPI: 1871633453
Provider Name (Legal Business Name): LEAH JO HUFFMAN R.D.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2074 S 6TH ST
KLAMATH FALLS OR
97601-3372
US

IV. Provider business mailing address

2074 S 6TH ST
KLAMATH FALLS OR
97601-3372
US

V. Phone/Fax

Practice location:
  • Phone: 541-880-2090
  • Fax: 541-880-2092
Mailing address:
  • Phone: 541-880-2090
  • Fax: 541-880-2092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH4158
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: