Provider Demographics
NPI:1508088477
Name:HUBENETTE, KIMBERLY QUAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:QUAN
Last Name:HUBENETTE
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 1:660 3RD ST W
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6805
Mailing Address - Country:US
Mailing Address - Phone:707-938-9066
Mailing Address - Fax:707-938-9106
Practice Address - Street 1:660 3RD ST W
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6805
Practice Address - Country:US
Practice Address - Phone:707-938-9066
Practice Address - Fax:707-938-9106
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA415221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice