MEDICARE: DR. TIM HUBBLE D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	8277	CO

General Provider Information

NPI Number	:	1225144900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIM HUBBLE D.M.D.

Provider Business Mailing Address
First Line	:	8120 S HOLLY ST
Second Line	:	STE 214
City	:	CENTENNIAL
State	:	CO
Zip	:	80122-4005
Country	:	US
Telephone Number	:	303-796-7676
Fax Number	:

Provider Business Practice Location Address
First Line	:	8120 S HOLLY ST
Second Line	:	STE 214
City	:	CENTENNIAL
State	:	CO
Zip	:	80122-4005
Country	:	US
Telephone Number	:	303-796-7676
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	07/08/2007

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