Provider Demographics
NPI:1417970161
Name:HUBER, DANIEL J (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:HUBER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 N CENTRAL AVE STE 607
Mailing Address - Street 2:IHS/ OHP
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-4424
Mailing Address - Country:US
Mailing Address - Phone:602-364-5190
Mailing Address - Fax:602-364-5025
Practice Address - Street 1:4212 N 16TH ST
Practice Address - Street 2:DENTAL
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5319
Practice Address - Country:US
Practice Address - Phone:602-263-1592
Practice Address - Fax:602-263-1608
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000091661223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0471490OtherBLUE CROSS
AZ415506Medicaid