Provider Demographics
NPI:1912080540
Name:HUFF, WALLACE L SR (DDS)
Entity type:Individual
Prefix:DR
First Name:WALLACE
Middle Name:L
Last Name:HUFF
Suffix:SR
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 1:3708 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-7007
Mailing Address - Country:US
Mailing Address - Phone:540-552-4781
Mailing Address - Fax:540-951-5037
Practice Address - Street 1:3708 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-7007
Practice Address - Country:US
Practice Address - Phone:540-552-4781
Practice Address - Fax:540-951-5037
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010041071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice