Healthcare Provider Details

I. General information

NPI: 1205198447
Provider Name (Legal Business Name): CRAIG HUBER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 06/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 N HILLSIDE ST
WICHITA KS
67214
US

IV. Provider business mailing address

109 S PUTTER DR
ANDOVER KS
67002-8823
US

V. Phone/Fax

Practice location:
  • Phone: 316-440-6400
  • Fax:
Mailing address:
  • Phone: 509-724-1977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60288276
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number61462
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: