Provider Demographics
NPI:1336402502
Name:HUBENAK, KATHERINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
Last Name:HUBENAK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26410 GREY HORSE RUN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-6281
Mailing Address - Country:US
Mailing Address - Phone:210-379-3909
Mailing Address - Fax:
Practice Address - Street 1:20770 US HIGHWAY 281 N STE 110
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-7500
Practice Address - Country:US
Practice Address - Phone:210-494-4455
Practice Address - Fax:210-496-1641
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice