Provider Demographics
NPI:1528263977
Name:KIMBERLY QUAN HUBENETTE,DDS, INC
Entity type:Organization
Organization Name:KIMBERLY QUAN HUBENETTE,DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:QUAN
Authorized Official - Last Name:HUBENETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-995-9234
Mailing Address - Street 1:5807 OWL HILL AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-4341
Mailing Address - Country:US
Mailing Address - Phone:619-995-9234
Mailing Address - Fax:707-537-9007
Practice Address - Street 1:5807 OWL HILL AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-4341
Practice Address - Country:US
Practice Address - Phone:619-995-9234
Practice Address - Fax:707-537-9007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA415221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty