Provider Demographics
NPI:1407944010
Name:HUBER,, KATHY ANN (DDS, FAGD)
Entity type:Individual
Prefix:DR
First Name:KATHY
Middle Name:ANN
Last Name:HUBER,
Suffix:
Gender:F
Credentials:DDS, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2352 MAIN ST E
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3335
Mailing Address - Country:US
Mailing Address - Phone:770-979-2110
Mailing Address - Fax:770-979-3233
Practice Address - Street 1:2352 MAIN ST E
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3335
Practice Address - Country:US
Practice Address - Phone:770-979-2110
Practice Address - Fax:770-979-3233
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9054122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist