Provider Demographics
NPI:1528152733
Name:HUFFMAN, LANNETTE R (DDS)
Entity type:Individual
Prefix:DR
First Name:LANNETTE
Middle Name:R
Last Name:HUFFMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LANNETTE
Other - Middle Name:R
Other - Last Name:HUFFMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1878 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LAKEPORT
Mailing Address - State:CA
Mailing Address - Zip Code:95453-3615
Mailing Address - Country:US
Mailing Address - Phone:707-263-7768
Mailing Address - Fax:707-263-1120
Practice Address - Street 1:1878 HIGH ST
Practice Address - Street 2:
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-3615
Practice Address - Country:US
Practice Address - Phone:707-263-7768
Practice Address - Fax:707-263-1120
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43796122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice