Provider Demographics
NPI:1982768271
Name:HUCKABEE, TIMOTHY MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:MICHAEL
Last Name:HUCKABEE
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 1:505 W SOUTHLAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6145
Mailing Address - Country:US
Mailing Address - Phone:817-329-4746
Mailing Address - Fax:817-488-3611
Practice Address - Street 1:505 W SOUTHLAKE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6145
Practice Address - Country:US
Practice Address - Phone:817-329-4746
Practice Address - Fax:817-488-3611
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX155081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX15508OtherDENTAL STATE LICENSE