Healthcare Provider Details

I. General information

NPI: 1245312990
Provider Name (Legal Business Name): MICHAEL J HUBER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8683 E LINCOLN AVE STE 210
LONE TREE CO
80124-9812
US

IV. Provider business mailing address

1175 KISTLER CT
HIGHLANDS RANCH CO
80126-4723
US

V. Phone/Fax

Practice location:
  • Phone: 303-799-3949
  • Fax: 303-792-5561
Mailing address:
  • Phone: 303-346-7035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number7448
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: