Healthcare Provider Details

I. General information

NPI: 1437270402
Provider Name (Legal Business Name): RAYMOND BRUCE HUZEK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2892 SCHUTT RD
BURKEVILLE VA
23922-2425
US

IV. Provider business mailing address

14421 MICHAUX VIEW WAY
MIDLOTHIAN VA
23113-6856
US

V. Phone/Fax

Practice location:
  • Phone: 434-767-5543
  • Fax: 434-767-2292
Mailing address:
  • Phone: 804-379-6465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401005339
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: