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General NPI Number Information
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NPI Number | 1417970161
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Entity Type | Individual
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Provider Name | DANIEL J HUBER DMD
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Gender | Male
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 4212 N 16TH ST DENTAL
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City | PHOENIX
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State | AZ
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Zip | 85016-5319
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Country | US
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Telephone | 602-263-1592
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Fax | 602-263-1608
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Provider Business Mailing Address
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Address Line | 40 N CENTRAL AVE STE 607 IHS/ OHP
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City | PHOENIX
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State | AZ
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Zip | 85004-4424
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Country | US
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Telephone | 602-364-5190
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Fax | 602-364-5025
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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 | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | DE00009166
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License Number State | WA
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