Provider Demographics
NPI:1174516363
Name:HUIZINGA, PAUL JAY (DDS MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JAY
Last Name:HUIZINGA
Suffix:
Gender:M
Credentials:DDS MD
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Mailing Address - Street 1:3919 PIUTE DR SW
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-2474
Mailing Address - Country:US
Mailing Address - Phone:616-534-4477
Mailing Address - Fax:
Practice Address - Street 1:4330 44TH ST SW
Practice Address - Street 2:SUITE 106
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2349
Practice Address - Country:US
Practice Address - Phone:616-530-4710
Practice Address - Fax:616-530-0480
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2010-08-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI2901018332204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4453238Medicaid
MI4453238Medicaid
MIH33439Medicare UPIN