Healthcare Provider Details

I. General information

NPI: 1528074754
Provider Name (Legal Business Name): STEVEN M HUFFSTUTLER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4968 OVERTON RIDGE BLVD
FORT WORTH TX
76132-1909
US

IV. Provider business mailing address

4968 OVERTON RIDGE BLVD
FORT WORTH TX
76132-1909
US

V. Phone/Fax

Practice location:
  • Phone: 817-263-0181
  • Fax: 817-292-8232
Mailing address:
  • Phone: 817-263-0181
  • Fax: 817-292-8232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number15510
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: