Provider Demographics
NPI:1659820413
Name:STEVEN W. HUBER, DDS & SAMUEL R. PELKEY, DMD, LLC
Entity type:Organization
Organization Name:STEVEN W. HUBER, DDS & SAMUEL R. PELKEY, DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:COMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-875-7070
Mailing Address - Street 1:13 PARK AVE W
Mailing Address - Street 2:SUITE 517
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44902-1714
Mailing Address - Country:US
Mailing Address - Phone:419-522-2523
Mailing Address - Fax:
Practice Address - Street 1:13 PARK AVE W
Practice Address - Street 2:SUITE 517
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44902-1714
Practice Address - Country:US
Practice Address - Phone:419-522-2523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH245641223G0001X
OH242491223G0001X
OH186191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty