Provider Demographics
NPI:1376867077
Name:HUBER DENTAL INCORPORATED
Entity Type:Organization
Organization Name:HUBER DENTAL INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HUBER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-498-9641
Mailing Address - Street 1:2377 MICHAEL DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320
Mailing Address - Country:US
Mailing Address - Phone:805-498-9641
Mailing Address - Fax:805-498-1981
Practice Address - Street 1:2377 MICHAEL DRIVE
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320
Practice Address - Country:US
Practice Address - Phone:805-498-9641
Practice Address - Fax:805-498-1981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-24
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44701122300000X
CA45707122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty