| Organization Name: | JOHN W HUDDART DDS LLC |
| NPI Number: | 1508148545 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHN W HUDDART (OWNER) |
| Mailing Address: | 611 Oak St Lathrop |
| State: | MO US |
| Postal Code: | 644659737 |
| Phone Number: | 8167404294 |
| Fax Number: | 8165284295 |
| NPI Enumeration Date: | 09/15/2011 |
| NPI Last Update Date: | 09/15/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 2001014206 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |