Provider Demographics
NPI:1659375533
Name:HUBER, TIMOTHY RAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:RAY
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 1:3600 RIVERS AVE
Mailing Address - Street 2:CODE 09MD.2
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-7769
Mailing Address - Country:US
Mailing Address - Phone:843-743-7868
Mailing Address - Fax:843-743-7521
Practice Address - Street 1:3600 RIVERS AVE
Practice Address - Street 2:CODE 09MD.2
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-7769
Practice Address - Country:US
Practice Address - Phone:843-743-7868
Practice Address - Fax:843-743-7521
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice