Provider Demographics
NPI:1659563070
Name:TUBB, HALI (RDH)
Entity Type:Individual
Prefix:
First Name:HALI
Middle Name:
Last Name:TUBB
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2033 W BEAUREGARD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-3883
Mailing Address - Country:US
Mailing Address - Phone:325-942-8577
Mailing Address - Fax:325-223-1480
Practice Address - Street 1:2029 W BEAUREGARD AVE
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-3812
Practice Address - Country:US
Practice Address - Phone:325-657-8154
Practice Address - Fax:325-486-9549
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14699124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist