Healthcare Provider Details

I. General information

NPI: 1134901309
Provider Name (Legal Business Name): COLE THOMAS HUBER DD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2023
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17800 TALBOT RD S # G
RENTON WA
98055-5740
US

IV. Provider business mailing address

23225 166TH AVE SE
KENT WA
98042-4701
US

V. Phone/Fax

Practice location:
  • Phone: 425-793-9433
  • Fax:
Mailing address:
  • Phone: 253-886-9360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License NumberDN.61451707
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: