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General NPI Number Information
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NPI Number | 1407209745
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Entity Type | Organization
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Legal Business Name | PAUL M HUFFAKER, DMD, PLLC
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Dates
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Enumeration Date | 07/22/2016
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Last Update Date | 05/04/2017
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Provider Practice Location Address
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Address Line | 134 S MAIN ST SUITE #4
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City | CENTERVILLE
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State | UT
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Zip | 84014-2814
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Country | US
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Telephone | 385-245-8247
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Fax |
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Provider Business Mailing Address
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Address Line | 134 S MAIN ST SUITE #4
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City | CENTERVILLE
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State | UT
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Zip | 84014-2814
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Country | US
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Telephone | 385-245-8247
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PAUL M HUFFAKER
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Credential | D.M.D.
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Telephone | 385-245-8247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 98296579922
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License Number State | UT
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