Basic Information
| Provider Information | |||||||||
| NPI: | 1578119244 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUETTNER | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | R | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2728 CEDAR SPRINGS RD APT 320 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752011432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104334348 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3360 W FM 544 STE 930 | ||||||||
| Address2: | |||||||||
| City: | WYLIE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750989429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729150484 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2019 | ||||||||
| LastUpdateDate: | 08/17/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 35623 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.