Basic Information
| Provider Information | |||||||||
| NPI: | 1932694825 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUEBNER | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | DOMINIK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9900 LINCOLN ST, 2ND FLOOR, ATTN: CREDENTIALS OFFICE | ||||||||
| Address2: | US ARMY DENTAC | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98327 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 9900 LINCOLN ST, 2ND FLOOR, ATTN: CREDENTIALS OFFICE | ||||||||
| Address2: | US ARMY DENTAC | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2536984079 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2018 | ||||||||
| LastUpdateDate: | 06/25/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 16484 | MD | Y | Dental Providers | Dentist |
No ID Information.