Provider Demographics
NPI:1306008792
Name:DR WILLIAM R HUBBELL JR DDS PC
Entity Type:Organization
Organization Name:DR WILLIAM R HUBBELL JR DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:HUBBELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-987-9666
Mailing Address - Street 1:1980 HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-1520
Mailing Address - Country:US
Mailing Address - Phone:810-987-9666
Mailing Address - Fax:810-987-6363
Practice Address - Street 1:1980 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-1520
Practice Address - Country:US
Practice Address - Phone:810-987-9666
Practice Address - Fax:810-987-6363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901011497122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty