Provider Demographics
NPI:1427110402
Name:HODGES KING & REUDEL HUBER DDS PA
Entity type:Organization
Organization Name:HODGES KING & REUDEL HUBER DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-952-1777
Mailing Address - Street 1:1000 CIRCLE 75 PKWY
Mailing Address - Street 2:STE 20
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-6079
Mailing Address - Country:US
Mailing Address - Phone:770-952-1777
Mailing Address - Fax:770-952-1779
Practice Address - Street 1:1000 CIRCLE 75 PKWY
Practice Address - Street 2:SUITE 20
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-6079
Practice Address - Country:US
Practice Address - Phone:770-952-1777
Practice Address - Fax:770-952-1779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN007445122300000X
GADN007477122300000X
GADN006968122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty