Provider Demographics
NPI:1326179292
Name:JEFFREY T HUISMAN D.D.S. PLLC
Entity type:Organization
Organization Name:JEFFREY T HUISMAN D.D.S. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:T
Authorized Official - Last Name:HUISMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-396-5919
Mailing Address - Street 1:397 120TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-2118
Mailing Address - Country:US
Mailing Address - Phone:616-396-5919
Mailing Address - Fax:616-396-9995
Practice Address - Street 1:397 120TH AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-2118
Practice Address - Country:US
Practice Address - Phone:616-396-5919
Practice Address - Fax:616-396-9995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI182631223G0001X
MI101411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty