Healthcare Provider Details

I. General information

NPI: 1730799255
Provider Name (Legal Business Name): NATHAN R HUBERT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2020
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20168 W 153RD ST
OLATHE KS
66062-9131
US

IV. Provider business mailing address

20168 W 153RD ST
OLATHE KS
66062-9131
US

V. Phone/Fax

Practice location:
  • Phone: 913-396-7625
  • Fax:
Mailing address:
  • Phone: 913-396-7625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDEN062329
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: