Provider Demographics
NPI:1548347701
Name:HUCKABAY, PAUL BRENT (DDS)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:BRENT
Last Name:HUCKABAY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:BRENT
Other - Middle Name:
Other - Last Name:HUCKABAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2000 W CUTHBERT AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-5729
Mailing Address - Country:US
Mailing Address - Phone:432-684-6672
Mailing Address - Fax:432-685-5036
Practice Address - Street 1:2000 W CUTHBERT AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5729
Practice Address - Country:US
Practice Address - Phone:432-684-6672
Practice Address - Fax:432-685-5036
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX138931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TND13893OtherBLUE CROSS BLUE SHIELD