=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114143971
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARVIN H. HUBER D.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2007
-----------------------------------------------------
Last Update Date | 12/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17800 TALBOT RD S STE G
-----------------------------------------------------
City | RENTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98055-5740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-793-9433
-----------------------------------------------------
Fax | 425-793-9435
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17800 TALBOT RD S STE G
-----------------------------------------------------
City | RENTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98055-5740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-793-9433
-----------------------------------------------------
Fax | 425-793-9435
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122400000X
-----------------------------------------------------
Taxonomy Name | Denturist
-----------------------------------------------------
License Number | DN256
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------