Healthcare Provider Details

I. General information

NPI: 1952487274
Provider Name (Legal Business Name): RICHARD JOHN HUBER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 GREAT MOOSE DR
HARTLAND ME
04943-3022
US

IV. Provider business mailing address

PO BOX 471
HARTLAND ME
04943-0471
US

V. Phone/Fax

Practice location:
  • Phone: 207-938-4835
  • Fax:
Mailing address:
  • Phone: 207-938-4835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2720
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: