Provider Demographics
NPI:1114143971
Name:HUBER, MARVIN H (DD)
Entity Type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:H
Last Name:HUBER
Suffix:
Gender:M
Credentials:DD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17800 TALBOT RD S STE G
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5740
Mailing Address - Country:US
Mailing Address - Phone:425-793-9433
Mailing Address - Fax:425-793-9435
Practice Address - Street 1:17800 TALBOT RD S STE G
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5740
Practice Address - Country:US
Practice Address - Phone:425-793-9433
Practice Address - Fax:425-793-9435
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN256122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5033956Medicare ID - Type UnspecifiedDSHS PROVIDER #