1760856918 NPI number — MATTHEW L. HUBIS DMD, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760856918 NPI number — MATTHEW L. HUBIS DMD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MATTHEW L. HUBIS DMD, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1760856918
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/25/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12925 HIGHWAY 601
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
MIDLAND
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28107-9535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-888-0607
Provider Business Mailing Address Fax Number:
704-888-0302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12925 HIGHWAY 601
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
MIDLAND
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28107-9535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-888-0607
Provider Business Practice Location Address Fax Number:
704-888-0302
Provider Enumeration Date:
11/25/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
CANDICE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OFFICE ADMINISTRATOR
Authorized Official Telephone Number:
704-888-0607

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  9416 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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