Healthcare Provider Details

I. General information

NPI: 1528206414
Provider Name (Legal Business Name): ANDREW FOSTER HUFF DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2009
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 BLACK COAL DR
FORT WASHAKIE WY
82514
US

IV. Provider business mailing address

PO BOX 128
FORT WASHAKIE WY
82514
US

V. Phone/Fax

Practice location:
  • Phone: 307-332-7300
  • Fax: 307-332-3949
Mailing address:
  • Phone: 307-332-7300
  • Fax: 307-332-3949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN10139
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: