Provider Demographics
NPI:1417005943
Name:HUFF, CALVIN WILLIS (DDS)
Entity type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:WILLIS
Last Name:HUFF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 GOLDEN DELICIOUS RD
Mailing Address - Street 2:
Mailing Address - City:CLARKESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30523-1386
Mailing Address - Country:US
Mailing Address - Phone:706-839-1636
Mailing Address - Fax:706-839-1634
Practice Address - Street 1:3059 LAWRENCEVILLE HWY
Practice Address - Street 2:STE. D
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-6426
Practice Address - Country:US
Practice Address - Phone:770-931-9996
Practice Address - Fax:706-839-1634
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0089911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice