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General NPI Number Information
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NPI Number | 1982768271
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Entity Type | Individual
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Provider Name | TIMOTHY MICHAEL HUCKABEE D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 08/18/2008
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Provider Practice Location Address
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Address Line | 505 W SOUTHLAKE BLVD
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6145
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Country | US
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Telephone | 817-329-4746
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Fax | 817-488-3611
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Provider Business Mailing Address
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Address Line | 505 W SOUTHLAKE BLVD
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6145
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Country | US
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Telephone | 817-329-4746
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Fax | 817-488-3611
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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 | 15508
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License Number State | TX
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