Provider Demographics
NPI:1063582419
Name:HUFF, CONSTANCE C (DMD)
Entity type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:C
Last Name:HUFF
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 COLLIN DR
Mailing Address - Street 2:
Mailing Address - City:HARRODSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40330-1168
Mailing Address - Country:US
Mailing Address - Phone:859-734-4944
Mailing Address - Fax:859-734-0476
Practice Address - Street 1:135 COLLIN DR
Practice Address - Street 2:
Practice Address - City:HARRODSBURG
Practice Address - State:KY
Practice Address - Zip Code:40330-1168
Practice Address - Country:US
Practice Address - Phone:859-734-4944
Practice Address - Fax:859-734-0476
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY59001223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60059003Medicaid