Provider Demographics
NPI:1275547556
Name:CUBBON, H TODD (DDS)
Entity Type:Individual
Prefix:DR
First Name:H
Middle Name:TODD
Last Name:CUBBON
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 1:24949 S WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-3447
Mailing Address - Country:US
Mailing Address - Phone:708-672-6012
Mailing Address - Fax:780-672-6619
Practice Address - Street 1:24560 S KINGS RD
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:IL
Practice Address - Zip Code:60417-9631
Practice Address - Country:US
Practice Address - Phone:708-672-6612
Practice Address - Fax:780-672-6619
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice