Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 5087 | IA |
NPI | 1124169032 |
---|---|
Provider Name | Dr. Lawrence R Huber |
First Address | Davenport, IA 52804 |
Second Address | Davenport, IA 52804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2007 |
Last Update Date | 08/07/2007 |