Provider Demographics
NPI:1487767711
Name:HUH, THERESA (DMD)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:
Last Name:HUH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 SILVER LN
Mailing Address - Street 2:SUITE 222
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06118-1296
Mailing Address - Country:US
Mailing Address - Phone:860-263-7791
Mailing Address - Fax:860-216-0316
Practice Address - Street 1:800 SILVER LN
Practice Address - Street 2:SUITE 222
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06118-1296
Practice Address - Country:US
Practice Address - Phone:860-263-7791
Practice Address - Fax:860-216-0316
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009843122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1487767711Medicaid
RITH60092Medicaid
RI8119-3OtherBLUE CROSS BLUE SHIELD