Provider Demographics
NPI:1174576383
Name:HUFFSTUTTER, LEONORA (DA)
Entity type:Individual
Prefix:
First Name:LEONORA
Middle Name:
Last Name:HUFFSTUTTER
Suffix:
Gender:F
Credentials:DA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 BEAVER RUIN RD
Mailing Address - Street 2:STE E
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093
Mailing Address - Country:US
Mailing Address - Phone:770-449-0836
Mailing Address - Fax:770-717-0150
Practice Address - Street 1:1480 BEAVER RUIN RD
Practice Address - Street 2:STE E
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093
Practice Address - Country:US
Practice Address - Phone:770-449-0836
Practice Address - Fax:770-717-0150
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist