Healthcare Provider Details

I. General information

NPI: 1699973719
Provider Name (Legal Business Name): TERRY W HUFF D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6402 SHERIDAN RD
KENOSHA WI
53143-5028
US

IV. Provider business mailing address

6402 SHERIDAN RD
KENOSHA WI
53143-5028
US

V. Phone/Fax

Practice location:
  • Phone: 262-654-2261
  • Fax: 262-657-6933
Mailing address:
  • Phone: 262-654-2261
  • Fax: 262-657-6933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5000910
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: