Provider Demographics
NPI:1437268364
Name:HUBER, DOUGLAS MERRILL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:MERRILL
Last Name:HUBER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 HAMPTON RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-3341
Mailing Address - Country:US
Mailing Address - Phone:702-294-1100
Mailing Address - Fax:702-294-1106
Practice Address - Street 1:453 HOTEL PLZ
Practice Address - Street 2:
Practice Address - City:BOULDER CITY
Practice Address - State:NV
Practice Address - Zip Code:89005-2621
Practice Address - Country:US
Practice Address - Phone:702-294-1100
Practice Address - Fax:702-294-1106
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV50601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice