Provider Demographics
NPI:1699973719
Name:HUFF, TERRY W (DDS)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:W
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 1:6402 SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-5028
Mailing Address - Country:US
Mailing Address - Phone:262-654-2261
Mailing Address - Fax:262-657-6933
Practice Address - Street 1:6402 SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-5028
Practice Address - Country:US
Practice Address - Phone:262-654-2261
Practice Address - Fax:262-657-6933
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50009101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33675300Medicaid