Provider Demographics
NPI:1205318086
Name:DENTALHUB
Entity type:Organization
Organization Name:DENTALHUB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUVERIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAKHRUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-308-7221
Mailing Address - Street 1:345 W FM 544
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-4408
Mailing Address - Country:US
Mailing Address - Phone:219-308-7221
Mailing Address - Fax:
Practice Address - Street 1:3483 W FM 544
Practice Address - Street 2:SUITE 112
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094
Practice Address - Country:US
Practice Address - Phone:219-308-7221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-29
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty