1548300841 NPI number — MRS. JACQUELINE GLORIA HUCKABEE DDS

Table of content: MRS. JACQUELINE GLORIA HUCKABEE DDS (NPI 1548300841)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548300841 NPI number — MRS. JACQUELINE GLORIA HUCKABEE DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUCKABEE
Provider First Name:
JACQUELINE
Provider Middle Name:
GLORIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548300841
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8151 E INDIAN BEND RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85250-4826
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-207-5047
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1743 W PRINCE RD
Provider Second Line Business Practice Location Address:
STE. 115
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85705-3092
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-408-2288
Provider Business Practice Location Address Fax Number:
520-514-7403
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  4151 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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