=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447232301
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROLYN HUFF D.D.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2005
-----------------------------------------------------
Last Update Date | 09/04/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 801 W 1ST ST
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78589
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-787-8915
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1689
-----------------------------------------------------
City | PHARR
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78577-1630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-787-8915
-----------------------------------------------------
Fax | 956-787-2021
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 14409
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------