Provider Demographics
NPI:1265811731
Name:HUBER, KARYL DESNEIGES (DN)
Entity type:Individual
Prefix:
First Name:KARYL
Middle Name:DESNEIGES
Last Name:HUBER
Suffix:
Gender:F
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 976
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:WA
Mailing Address - Zip Code:98356-0976
Mailing Address - Country:US
Mailing Address - Phone:541-729-1095
Mailing Address - Fax:
Practice Address - Street 1:209 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:WA
Practice Address - Zip Code:98356-0976
Practice Address - Country:US
Practice Address - Phone:541-729-1095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-29
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN60207531122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADN60207531Medicaid