Provider Demographics
NPI:1730399890
Name:CHARCHUT, HEATHER HUFFER (D M D)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:HUFFER
Last Name:CHARCHUT
Suffix:
Gender:F
Credentials:D M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5907 COVENTRY CIR
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-7781
Mailing Address - Country:US
Mailing Address - Phone:517-339-2140
Mailing Address - Fax:
Practice Address - Street 1:5238 W ST JOE HWY
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-4085
Practice Address - Country:US
Practice Address - Phone:517-321-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010184751223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics