Provider Demographics
NPI:1669804050
Name:HUBER, PHILLIP S (DDS)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:S
Last Name:HUBER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 PEPPERTREE DR
Mailing Address - Street 2:APT 4
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-2905
Mailing Address - Country:US
Mailing Address - Phone:561-866-7854
Mailing Address - Fax:
Practice Address - Street 1:93 PEPPERTREE DR
Practice Address - Street 2:APT 4
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2905
Practice Address - Country:US
Practice Address - Phone:561-866-7854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0566981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice