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General NPI Number Information
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NPI Number | 1205198447
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Entity Type | Individual
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Provider Name | CRAIG HUBER DDS
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Gender | Male
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Dates
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Enumeration Date | 06/13/2012
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Last Update Date | 06/08/2018
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Provider Practice Location Address
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Address Line | 233 N HILLSIDE ST
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City | WICHITA
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State | KS
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Zip | 67214
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Country | US
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Telephone | 316-440-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 109 S PUTTER DR
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City | ANDOVER
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State | KS
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Zip | 67002-8823
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Country | US
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Telephone | 509-724-1977
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 61462
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE60288276
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License Number State | WA
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