Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DE00009166 | WA |
NPI | 1417970161 |
---|---|
Provider Name | Dr. Daniel J Huber |
First Address | Phoenix, AZ 85004-4424 |
Second Address | Phoenix, AZ 85016-5319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
415506 | (05) | AZ |
AZ0471490 | BLUE CROSS (01) | AZ |