Provider Demographics
NPI:1023011301
Name:HUBBARD, GARY R (DDS)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:R
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 COOLIDGE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-8014
Mailing Address - Country:US
Mailing Address - Phone:517-332-2422
Mailing Address - Fax:517-332-0810
Practice Address - Street 1:3515 COOLIDGE RD
Practice Address - Street 2:SUITE C
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8014
Practice Address - Country:US
Practice Address - Phone:517-332-2422
Practice Address - Fax:517-332-0810
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2012-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI118211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice